{ "hospital_name": "Landmark Medical Center", "last_updated_on": "2025-12-09","version": "2.2.0", "hospital_location": ["Landmark Medical Center"],"hospital_address": [ "115 Cass Avenue Woonsocket, RI 02895" ], "license_information": { "license_number": "461175423", "state": "RI" }, "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 Pfizer-Biontech Covid-19 Vaccine Administration – First Dose", "code_information": [ { "code": "0001A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.98,"maximum": 40,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 19.53, "standard_charge_percentage": 48.8300, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 35, "standard_charge_percentage": 87.5000, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 38, "standard_charge_percentage": 95.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 14.2, "standard_charge_percentage": 35.5000, "estimated_amount": 14, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 26.8, "standard_charge_percentage": 67.0000, "estimated_amount": 26, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 30, "standard_charge_percentage": 75.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 9.36, "standard_charge_percentage": 23.3900, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 8.32, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10.11, "standard_charge_percentage": 25.2800, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose", "code_information": [ { "code": "0002A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.98,"maximum": 40,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 30, "standard_charge_percentage": 75.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 9.36, "standard_charge_percentage": 23.3900, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 8.32, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 19.53, "standard_charge_percentage": 48.8300, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 35, "standard_charge_percentage": 87.5000, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10.11, "standard_charge_percentage": 25.2800, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 14.2, "standard_charge_percentage": 35.5000, "estimated_amount": 14, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 38, "standard_charge_percentage": 95.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 26.8, "standard_charge_percentage": 67.0000, "estimated_amount": 26, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Pfizer-Biontech Covid-19 Vaccine Administration – Third Dose", "code_information": [ { "code": "0003A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.98,"maximum": 40,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 26.8, "standard_charge_percentage": 67.0000, "estimated_amount": 26, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 9.36, "standard_charge_percentage": 23.3900, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 38, "standard_charge_percentage": 95.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 14.2, "standard_charge_percentage": 35.5000, "estimated_amount": 14, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 30, "standard_charge_percentage": 75.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 35, "standard_charge_percentage": 87.5000, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 19.53, "standard_charge_percentage": 48.8300, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 8.32, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10.11, "standard_charge_percentage": 25.2800, "estimated_amount": 10, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Liver Dis 10 Assays W/Nash", "code_information": [ { "code": "0003M", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2517, "discounted_cash": 654,"minimum": 502.14,"maximum": 2391.15,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 502.14, "standard_charge_percentage": 21.0000, "estimated_amount": 502, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1761.9, "standard_charge_percentage": 70.0000, "estimated_amount": 1761, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 899.52, "estimated_amount": 899, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 528.57, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 513.47, "estimated_amount": 513, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 513.47, "estimated_amount": 513, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2265.3, "standard_charge_percentage": 90.0000, "estimated_amount": 2265, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1761.9, "standard_charge_percentage": 70.0000, "estimated_amount": 1761, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 512.71, "standard_charge_percentage": 21.0000, "estimated_amount": 512, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1761.9, "standard_charge_percentage": 70.0000, "estimated_amount": 1761, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 566.44, "estimated_amount": 566, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1258.5, "standard_charge_percentage": 50.0000, "estimated_amount": 1258, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 512.71, "standard_charge_percentage": 21.0000, "estimated_amount": 512, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 536.62, "estimated_amount": 536, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2265.3, "standard_charge_percentage": 90.0000, "estimated_amount": 2265, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1510.2, "standard_charge_percentage": 60.0000, "estimated_amount": 1510, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 512.71, "standard_charge_percentage": 21.0000, "estimated_amount": 512, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 523.28, "standard_charge_percentage": 21.0000, "estimated_amount": 523, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 512.71, "standard_charge_percentage": 21.0000, "estimated_amount": 512, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 755.1, "standard_charge_percentage": 30.0000, "estimated_amount": 755, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2391.15, "standard_charge_percentage": 95.0000, "estimated_amount": 2391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 528.57, "standard_charge_percentage": 21.0000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2265.3, "standard_charge_percentage": 90.0000, "estimated_amount": 2265, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 502.14, "standard_charge_percentage": 21.0000, "estimated_amount": 502, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 704.76, "estimated_amount": 704, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 503.4, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 528.57, "standard_charge_percentage": 21.0000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1887.75, "standard_charge_percentage": 75.0000, "estimated_amount": 1887, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2202.38, "standard_charge_percentage": 87.5000, "estimated_amount": 2202, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2139.45, "standard_charge_percentage": 85.0000, "estimated_amount": 2139, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Pfizer-Biontech Covid-19 Vaccine Administration – Booster Dose", "code_information": [ { "code": "0004A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.98,"maximum": 40,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 19.53, "standard_charge_percentage": 48.8300, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 8.32, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 38, "standard_charge_percentage": 95.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10.11, "standard_charge_percentage": 25.2800, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 9.36, "standard_charge_percentage": 23.3900, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 26.8, "standard_charge_percentage": 67.0000, "estimated_amount": 26, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 14.2, "standard_charge_percentage": 35.5000, "estimated_amount": 14, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 30, "standard_charge_percentage": 75.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 35, "standard_charge_percentage": 87.5000, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Moderna Covid-19 Vaccine Administration – First Dose", "code_information": [ { "code": "0011A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.98,"maximum": 38,"payers_information":[{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 26.8, "standard_charge_percentage": 67.0000, "estimated_amount": 26, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 9.36, "standard_charge_percentage": 23.3900, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 30, "standard_charge_percentage": 75.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 35, "standard_charge_percentage": 87.5000, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 8.32, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 19.53, "standard_charge_percentage": 48.8300, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10.11, "standard_charge_percentage": 25.2800, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 38, "standard_charge_percentage": 95.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 14.2, "standard_charge_percentage": 35.5000, "estimated_amount": 14, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Moderna Covid-19 Vaccine Administration – Second Dose", "code_information": [ { "code": "0012A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.98,"maximum": 40,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 30, "standard_charge_percentage": 75.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 26.8, "standard_charge_percentage": 67.0000, "estimated_amount": 26, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10.11, "standard_charge_percentage": 25.2800, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 14.2, "standard_charge_percentage": 35.5000, "estimated_amount": 14, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 9.36, "standard_charge_percentage": 23.3900, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 19.53, "standard_charge_percentage": 48.8300, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 38, "standard_charge_percentage": 95.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 8.32, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 35, "standard_charge_percentage": 87.5000, "estimated_amount": 35, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Moderna Covid-19 Vaccine Administration – Third Dose", "code_information": [ { "code": "0013A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.98,"maximum": 38,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 38, "standard_charge_percentage": 95.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 35, "standard_charge_percentage": 87.5000, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 8.32, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10.11, "standard_charge_percentage": 25.2800, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 14.2, "standard_charge_percentage": 35.5000, "estimated_amount": 14, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 19.53, "standard_charge_percentage": 48.8300, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 9.36, "standard_charge_percentage": 23.3900, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 30, "standard_charge_percentage": 75.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 26.8, "standard_charge_percentage": 67.0000, "estimated_amount": 26, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Astrazeneca Covid-19 Vaccine Administration – First Dose", "code_information": [ { "code": "0021A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.98,"maximum": 38,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 35, "standard_charge_percentage": 87.5000, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 30, "standard_charge_percentage": 75.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 38, "standard_charge_percentage": 95.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10.11, "standard_charge_percentage": 25.2800, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 8.32, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 9.36, "standard_charge_percentage": 23.3900, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 19.53, "standard_charge_percentage": 48.8300, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 14.2, "standard_charge_percentage": 35.5000, "estimated_amount": 14, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 26.8, "standard_charge_percentage": 67.0000, "estimated_amount": 26, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Astrazeneca Covid-19 Vaccine Administration – Second Dose", "code_information": [ { "code": "0022A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.98,"maximum": 38,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 8.32, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 38, "standard_charge_percentage": 95.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 26.8, "standard_charge_percentage": 67.0000, "estimated_amount": 26, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 35, "standard_charge_percentage": 87.5000, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 9.36, "standard_charge_percentage": 23.3900, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10.11, "standard_charge_percentage": 25.2800, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 14.2, "standard_charge_percentage": 35.5000, "estimated_amount": 14, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 19.53, "standard_charge_percentage": 48.8300, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 30, "standard_charge_percentage": 75.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Imm Admn Sarscov2 Ad26 5X1010 Vp/0.5 Ml 1 Dose", "code_information": [ { "code": "0031A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.98,"maximum": 40,"payers_information":[{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 8.32, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 35, "standard_charge_percentage": 87.5000, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 38, "standard_charge_percentage": 95.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 26.8, "standard_charge_percentage": 67.0000, "estimated_amount": 26, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 14.2, "standard_charge_percentage": 35.5000, "estimated_amount": 14, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 30, "standard_charge_percentage": 75.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 19.53, "standard_charge_percentage": 48.8300, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10.11, "standard_charge_percentage": 25.2800, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 9.36, "standard_charge_percentage": 23.3900, "estimated_amount": 9, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Johnson&Johnson Covid-19 Vaccine Administration - Booster Dose", "code_information": [ { "code": "0034A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.98,"maximum": 40,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 9.36, "standard_charge_percentage": 23.3900, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10.11, "standard_charge_percentage": 25.2800, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 35, "standard_charge_percentage": 87.5000, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 26.8, "standard_charge_percentage": 67.0000, "estimated_amount": 26, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 30, "standard_charge_percentage": 75.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 8.32, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 19.53, "standard_charge_percentage": 48.8300, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 38, "standard_charge_percentage": 95.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 14.2, "standard_charge_percentage": 35.5000, "estimated_amount": 14, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Neuro Csf Detcj Prion Prtn Quakg Conf Conv Qual", "code_information": [ { "code": "0035U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2704.95, "discounted_cash": 703,"minimum": 410.77,"maximum": 2569.7,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2569.7, "standard_charge_percentage": 95.0000, "estimated_amount": 2569, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 540.99, "estimated_amount": 540, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2163.96, "standard_charge_percentage": 80.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 410.77, "estimated_amount": 410, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2163.96, "standard_charge_percentage": 80.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1352.47, "standard_charge_percentage": 50.0000, "estimated_amount": 1352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2163.96, "standard_charge_percentage": 80.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 540.99, "estimated_amount": 540, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 551.81, "estimated_amount": 551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 758.33, "estimated_amount": 758, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 540.99, "estimated_amount": 540, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2163.96, "standard_charge_percentage": 80.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1622.97, "standard_charge_percentage": 60.0000, "estimated_amount": 1622, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2299.21, "standard_charge_percentage": 85.0000, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1893.46, "standard_charge_percentage": 70.0000, "estimated_amount": 1893, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 539.64, "standard_charge_percentage": 21.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2163.96, "standard_charge_percentage": 80.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1352.47, "standard_charge_percentage": 50.0000, "estimated_amount": 1352, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2366.83, "standard_charge_percentage": 87.5000, "estimated_amount": 2366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1893.46, "standard_charge_percentage": 70.0000, "estimated_amount": 1893, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 539.64, "standard_charge_percentage": 21.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 568.04, "estimated_amount": 568, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 477.53, "estimated_amount": 477, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 540.99, "estimated_amount": 540, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2163.96, "standard_charge_percentage": 80.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 540.99, "estimated_amount": 540, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 551, "standard_charge_percentage": 21.0000, "estimated_amount": 551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 811.49, "standard_charge_percentage": 30.0000, "estimated_amount": 811, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2163.96, "standard_charge_percentage": 80.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 562.36, "standard_charge_percentage": 21.0000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1893.46, "standard_charge_percentage": 70.0000, "estimated_amount": 1893, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2163.96, "standard_charge_percentage": 80.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 551, "standard_charge_percentage": 21.0000, "estimated_amount": 551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 757.39, "estimated_amount": 757, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 551, "standard_charge_percentage": 21.0000, "estimated_amount": 551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 540.99, "estimated_amount": 540, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2163.96, "standard_charge_percentage": 80.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 540.99, "estimated_amount": 540, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2163.96, "standard_charge_percentage": 80.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2028.71, "standard_charge_percentage": 75.0000, "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 551.81, "estimated_amount": 551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 540.99, "estimated_amount": 540, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 568.04, "standard_charge_percentage": 21.0000, "estimated_amount": 568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 540.99, "estimated_amount": 540, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2434.45, "standard_charge_percentage": 90.0000, "estimated_amount": 2434, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 568.04, "standard_charge_percentage": 21.0000, "estimated_amount": 568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 540.99, "estimated_amount": 540, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 551, "standard_charge_percentage": 21.0000, "estimated_amount": 551, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2434.45, "standard_charge_percentage": 90.0000, "estimated_amount": 2434, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2434.45, "standard_charge_percentage": 90.0000, "estimated_amount": 2434, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 540.99, "estimated_amount": 540, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 540.99, "estimated_amount": 540, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "00410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 620,"minimum": 123.69,"maximum": 589,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 465, "standard_charge_percentage": 75.0000, "estimated_amount": 465, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 496, "standard_charge_percentage": 80.0000, "estimated_amount": 496, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 542.5, "standard_charge_percentage": 87.5000, "estimated_amount": 542, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 558, "standard_charge_percentage": 90.0000, "estimated_amount": 558, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 496, "standard_charge_percentage": 80.0000, "estimated_amount": 496, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 589, "standard_charge_percentage": 95.0000, "estimated_amount": 589, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 126.29, "standard_charge_percentage": 21.0000, "estimated_amount": 126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 496, "standard_charge_percentage": 80.0000, "estimated_amount": 496, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 496, "standard_charge_percentage": 80.0000, "estimated_amount": 496, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 220.1, "standard_charge_percentage": 35.5000, "estimated_amount": 220, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 128.9, "standard_charge_percentage": 21.0000, "estimated_amount": 128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 123.69, "standard_charge_percentage": 21.0000, "estimated_amount": 123, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 310, "standard_charge_percentage": 50.0000, "estimated_amount": 310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 434, "standard_charge_percentage": 70.0000, "estimated_amount": 434, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 496, "standard_charge_percentage": 80.0000, "estimated_amount": 496, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 434, "standard_charge_percentage": 70.0000, "estimated_amount": 434, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 130.2, "standard_charge_percentage": 21.0000, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 434, "standard_charge_percentage": 70.0000, "estimated_amount": 434, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 558, "standard_charge_percentage": 90.0000, "estimated_amount": 558, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 496, "standard_charge_percentage": 80.0000, "estimated_amount": 496, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 123.69, "standard_charge_percentage": 21.0000, "estimated_amount": 123, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 372, "standard_charge_percentage": 60.0000, "estimated_amount": 372, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 558, "standard_charge_percentage": 90.0000, "estimated_amount": 558, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 310, "standard_charge_percentage": 50.0000, "estimated_amount": 310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 186, "standard_charge_percentage": 30.0000, "estimated_amount": 186, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 527, "standard_charge_percentage": 85.0000, "estimated_amount": 527, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 496, "standard_charge_percentage": 80.0000, "estimated_amount": 496, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 496, "standard_charge_percentage": 80.0000, "estimated_amount": 496, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 496, "standard_charge_percentage": 80.0000, "estimated_amount": 496, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 126.29, "standard_charge_percentage": 21.0000, "estimated_amount": 126, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 126.29, "standard_charge_percentage": 21.0000, "estimated_amount": 126, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 403.74, "standard_charge_percentage": 65.1200, "estimated_amount": 403, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 126.29, "standard_charge_percentage": 21.0000, "estimated_amount": 126, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 496, "standard_charge_percentage": 80.0000, "estimated_amount": 496, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 130.2, "standard_charge_percentage": 21.0000, "estimated_amount": 130, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Moderna Covid-19 Vaccine Administration – Booster Dose", "code_information": [ { "code": "0064A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40,"minimum": 7.98,"maximum": 40,"payers_information":[{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 14.2, "standard_charge_percentage": 35.5000, "estimated_amount": 14, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10.11, "standard_charge_percentage": 25.2800, "estimated_amount": 10, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 34, "standard_charge_percentage": 85.0000, "estimated_amount": 34, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 24, "standard_charge_percentage": 60.0000, "estimated_amount": 24, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 8.32, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12, "standard_charge_percentage": 30.0000, "estimated_amount": 12, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 38, "standard_charge_percentage": 95.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 35, "standard_charge_percentage": 87.5000, "estimated_amount": 35, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 9.36, "standard_charge_percentage": 23.3900, "estimated_amount": 9, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 8.4, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 7.98, "standard_charge_percentage": 21.0000, "estimated_amount": 7, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 36, "standard_charge_percentage": 90.0000, "estimated_amount": 36, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 8.15, "standard_charge_percentage": 21.0000, "estimated_amount": 8, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 28, "standard_charge_percentage": 70.0000, "estimated_amount": 28, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 30, "standard_charge_percentage": 75.0000, "estimated_amount": 30, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 20, "standard_charge_percentage": 50.0000, "estimated_amount": 20, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 26.8, "standard_charge_percentage": 67.0000, "estimated_amount": 26, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32, "standard_charge_percentage": 80.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 19.53, "standard_charge_percentage": 48.8300, "estimated_amount": 19, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 40, "estimated_amount": 40, "methodology": "fee schedule" }]}]} , { "description": "Hc Anesth Vag Delivery, Epidural", "code_information": [ { "code": "01967", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1151.33,"minimum": 229.69,"maximum": 1093.76,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 921.06, "standard_charge_percentage": 80.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 863.5, "standard_charge_percentage": 75.0000, "estimated_amount": 863, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 690.8, "standard_charge_percentage": 60.0000, "estimated_amount": 690, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 921.06, "standard_charge_percentage": 80.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 241.78, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 239.36, "standard_charge_percentage": 21.0000, "estimated_amount": 239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 345.4, "standard_charge_percentage": 30.0000, "estimated_amount": 345, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 241.78, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 575.66, "standard_charge_percentage": 50.0000, "estimated_amount": 575, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1036.2, "standard_charge_percentage": 90.0000, "estimated_amount": 1036, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1036.2, "standard_charge_percentage": 90.0000, "estimated_amount": 1036, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 575.66, "standard_charge_percentage": 50.0000, "estimated_amount": 575, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1036.2, "standard_charge_percentage": 90.0000, "estimated_amount": 1036, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 234.53, "standard_charge_percentage": 21.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 234.53, "standard_charge_percentage": 21.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 921.06, "standard_charge_percentage": 80.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1093.76, "standard_charge_percentage": 95.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 921.06, "standard_charge_percentage": 80.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 229.69, "standard_charge_percentage": 21.0000, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 749.75, "standard_charge_percentage": 65.1200, "estimated_amount": 749, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 921.06, "standard_charge_percentage": 80.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 921.06, "standard_charge_percentage": 80.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 921.06, "standard_charge_percentage": 80.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 978.63, "standard_charge_percentage": 85.0000, "estimated_amount": 978, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 234.53, "standard_charge_percentage": 21.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 805.93, "standard_charge_percentage": 70.0000, "estimated_amount": 805, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 408.72, "standard_charge_percentage": 35.5000, "estimated_amount": 408, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 805.93, "standard_charge_percentage": 70.0000, "estimated_amount": 805, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1007.41, "standard_charge_percentage": 87.5000, "estimated_amount": 1007, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 921.06, "standard_charge_percentage": 80.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 234.53, "standard_charge_percentage": 21.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 805.93, "standard_charge_percentage": 70.0000, "estimated_amount": 805, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 921.06, "standard_charge_percentage": 80.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 229.69, "standard_charge_percentage": 21.0000, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 921.06, "standard_charge_percentage": 80.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" }]}]} , { "description": "Perq sacral augmt bilat inj", "code_information": [ { "code": "0201T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31324.8, "discounted_cash": 10131,"minimum": 1287,"maximum": 29758.6,"payers_information":[{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 25059.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25059, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9397.44, "standard_charge_percentage": 30.0000, "estimated_amount": 9397, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 8183.2, "estimated_amount": 8183, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1287, "estimated_amount": 1287, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 28192.3, "standard_charge_percentage": 90.0000, "estimated_amount": 28192, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5854, "estimated_amount": 5854, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 25059.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25059, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 6249.3, "standard_charge_percentage": 21.0000, "estimated_amount": 6249, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 26626.1, "standard_charge_percentage": 85.0000, "estimated_amount": 26626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 21927.4, "standard_charge_percentage": 70.0000, "estimated_amount": 21927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 21927.4, "standard_charge_percentage": 70.0000, "estimated_amount": 21927, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 25059.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25059, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 28192.3, "standard_charge_percentage": 90.0000, "estimated_amount": 28192, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 6578.21, "standard_charge_percentage": 21.0000, "estimated_amount": 6578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 25059.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25059, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 6380.86, "standard_charge_percentage": 21.0000, "estimated_amount": 6380, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 15662.4, "standard_charge_percentage": 50.0000, "estimated_amount": 15662, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 29758.6, "standard_charge_percentage": 95.0000, "estimated_amount": 29758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10910.9, "estimated_amount": 10910, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 6928.44, "estimated_amount": 6928, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 6249.3, "standard_charge_percentage": 21.0000, "estimated_amount": 6249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 6578.21, "standard_charge_percentage": 21.0000, "estimated_amount": 6578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 25059.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25059, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2695.58, "estimated_amount": 2695, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4280.66, "estimated_amount": 4280, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 21927.4, "standard_charge_percentage": 70.0000, "estimated_amount": 21927, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 25059.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25059, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 6380.86, "standard_charge_percentage": 21.0000, "estimated_amount": 6380, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 25059.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25059, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 25059.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25059, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 18794.9, "standard_charge_percentage": 60.0000, "estimated_amount": 18794, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 25059.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25059, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 6380.86, "standard_charge_percentage": 21.0000, "estimated_amount": 6380, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 6512.43, "standard_charge_percentage": 21.0000, "estimated_amount": 6512, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 28192.3, "standard_charge_percentage": 90.0000, "estimated_amount": 28192, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 27409.2, "standard_charge_percentage": 87.5000, "estimated_amount": 27409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 15662.4, "standard_charge_percentage": 50.0000, "estimated_amount": 15662, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 25059.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25059, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 8307.89, "estimated_amount": 8307, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 6380.86, "standard_charge_percentage": 21.0000, "estimated_amount": 6380, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 23493.6, "standard_charge_percentage": 75.0000, "estimated_amount": 23493, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Nfct Ds Bct/Vir Respir Dna/Rna 22 Trgt Sarscov2", "code_information": [ { "code": "0202U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2083.9, "discounted_cash": 541,"minimum": 316.46,"maximum": 1979.7,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 415.74, "standard_charge_percentage": 21.0000, "estimated_amount": 415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 425.12, "estimated_amount": 425, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 444.29, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1875.51, "standard_charge_percentage": 90.0000, "estimated_amount": 1875, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1979.7, "standard_charge_percentage": 95.0000, "estimated_amount": 1979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 415.74, "standard_charge_percentage": 21.0000, "estimated_amount": 415, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 424.49, "standard_charge_percentage": 21.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1458.73, "standard_charge_percentage": 70.0000, "estimated_amount": 1458, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 437.62, "standard_charge_percentage": 21.0000, "estimated_amount": 437, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1771.32, "standard_charge_percentage": 85.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1041.95, "standard_charge_percentage": 50.0000, "estimated_amount": 1041, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 424.49, "standard_charge_percentage": 21.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 424.49, "standard_charge_percentage": 21.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 526.81, "standard_charge_percentage": 25.2800, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 487.42, "standard_charge_percentage": 23.3900, "estimated_amount": 416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1875.51, "standard_charge_percentage": 90.0000, "estimated_amount": 1875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1041.95, "standard_charge_percentage": 50.0000, "estimated_amount": 1041, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 433.24, "standard_charge_percentage": 21.0000, "estimated_amount": 433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1562.92, "standard_charge_percentage": 75.0000, "estimated_amount": 1562, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 425.12, "estimated_amount": 425, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 583.49, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 437.62, "standard_charge_percentage": 21.0000, "estimated_amount": 437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 437.62, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1458.73, "standard_charge_percentage": 70.0000, "estimated_amount": 1458, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 316.46, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1458.73, "standard_charge_percentage": 70.0000, "estimated_amount": 1458, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 424.49, "standard_charge_percentage": 21.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 739.78, "standard_charge_percentage": 35.5000, "estimated_amount": 739, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1667.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 625.17, "standard_charge_percentage": 30.0000, "estimated_amount": 625, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1823.41, "standard_charge_percentage": 87.5000, "estimated_amount": 1823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1017.57, "standard_charge_percentage": 48.8300, "estimated_amount": 1017, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1250.34, "standard_charge_percentage": 60.0000, "estimated_amount": 1250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 416.78, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1875.51, "standard_charge_percentage": 90.0000, "estimated_amount": 1875, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Translum Peripheral Atherectomy Renal Art", "code_information": [ { "code": "0234T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47711.8, "discounted_cash": 16083,"minimum": 1551,"maximum": 45326.2,"payers_information":[{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 20039, "standard_charge_percentage": 42.0000, "estimated_amount": 20038, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 19437.8, "standard_charge_percentage": 42.0000, "estimated_amount": 19437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 16937.7, "standard_charge_percentage": 35.5000, "estimated_amount": 16937, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 40555, "standard_charge_percentage": 85.0000, "estimated_amount": 40555, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 42940.6, "standard_charge_percentage": 90.0000, "estimated_amount": 42940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1551, "estimated_amount": 1551, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 19838.6, "standard_charge_percentage": 42.0000, "estimated_amount": 19838, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 17051.2, "estimated_amount": 17051, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 42940.6, "standard_charge_percentage": 90.0000, "estimated_amount": 42940, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 33398.3, "standard_charge_percentage": 70.0000, "estimated_amount": 33398, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 19037, "standard_charge_percentage": 42.0000, "estimated_amount": 19037, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 23855.9, "standard_charge_percentage": 50.0000, "estimated_amount": 23855, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6917, "estimated_amount": 6917, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 42940.6, "standard_charge_percentage": 90.0000, "estimated_amount": 42940, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 41747.8, "standard_charge_percentage": 87.5000, "estimated_amount": 41747, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 33398.3, "standard_charge_percentage": 70.0000, "estimated_amount": 33398, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 35783.8, "standard_charge_percentage": 75.0000, "estimated_amount": 35783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 23855.9, "standard_charge_percentage": 50.0000, "estimated_amount": 23855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 12990.7, "estimated_amount": 12990, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 13188.7, "estimated_amount": 13188, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 19037, "standard_charge_percentage": 42.0000, "estimated_amount": 19037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 12619.5, "estimated_amount": 12619, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 14313.5, "standard_charge_percentage": 30.0000, "estimated_amount": 14313, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 19437.8, "standard_charge_percentage": 42.0000, "estimated_amount": 19437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 10998.8, "estimated_amount": 10998, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17320.9, "estimated_amount": 17320, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 12619.5, "estimated_amount": 12619, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 19437.8, "standard_charge_percentage": 42.0000, "estimated_amount": 19437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 8714.14, "estimated_amount": 8714, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 45326.2, "standard_charge_percentage": 95.0000, "estimated_amount": 45326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 28627.1, "standard_charge_percentage": 60.0000, "estimated_amount": 28627, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 33398.3, "standard_charge_percentage": 70.0000, "estimated_amount": 33398, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 19437.8, "standard_charge_percentage": 42.0000, "estimated_amount": 19437, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 20039, "standard_charge_percentage": 42.0000, "estimated_amount": 20038, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 8714.14, "estimated_amount": 8714, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10737.3, "estimated_amount": 10737, "methodology": "fee schedule" }]}]} , { "description": "Hc Translum Peripheral Atherectomy Visceral Art Ea", "code_information": [ { "code": "0235T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2850.35,"minimum": 855.11,"maximum": 2850.35,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1710.21, "standard_charge_percentage": 60.0000, "estimated_amount": 1710, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1197.15, "standard_charge_percentage": 42.0000, "estimated_amount": 1197, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2850.35, "estimated_amount": 2850, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2565.32, "standard_charge_percentage": 90.0000, "estimated_amount": 2565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2280.28, "standard_charge_percentage": 80.0000, "estimated_amount": 2280, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1425.17, "standard_charge_percentage": 50.0000, "estimated_amount": 1425, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2280.28, "standard_charge_percentage": 80.0000, "estimated_amount": 2280, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2280.28, "standard_charge_percentage": 80.0000, "estimated_amount": 2280, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2639, "estimated_amount": 2639, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 855.11, "standard_charge_percentage": 30.0000, "estimated_amount": 855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1011.87, "standard_charge_percentage": 35.5000, "estimated_amount": 1011, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2280.28, "standard_charge_percentage": 80.0000, "estimated_amount": 2280, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2280.28, "standard_charge_percentage": 80.0000, "estimated_amount": 2280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2137.76, "standard_charge_percentage": 75.0000, "estimated_amount": 2137, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2707.83, "standard_charge_percentage": 95.0000, "estimated_amount": 2707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1995.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1995, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1185.18, "standard_charge_percentage": 42.0000, "estimated_amount": 1185, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2494.06, "standard_charge_percentage": 87.5000, "estimated_amount": 2494, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2280.28, "standard_charge_percentage": 80.0000, "estimated_amount": 2280, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2565.32, "standard_charge_percentage": 90.0000, "estimated_amount": 2565, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2565.32, "standard_charge_percentage": 90.0000, "estimated_amount": 2565, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1161.23, "standard_charge_percentage": 42.0000, "estimated_amount": 1161, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2280.28, "standard_charge_percentage": 80.0000, "estimated_amount": 2280, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1161.23, "standard_charge_percentage": 42.0000, "estimated_amount": 1161, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1161.23, "standard_charge_percentage": 42.0000, "estimated_amount": 1161, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2422.8, "standard_charge_percentage": 85.0000, "estimated_amount": 2422, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1137.29, "standard_charge_percentage": 42.0000, "estimated_amount": 1137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1425.17, "standard_charge_percentage": 50.0000, "estimated_amount": 1425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1137.29, "standard_charge_percentage": 42.0000, "estimated_amount": 1137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1995.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1995, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2280.28, "standard_charge_percentage": 80.0000, "estimated_amount": 2280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1197.15, "standard_charge_percentage": 42.0000, "estimated_amount": 1197, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2280.28, "standard_charge_percentage": 80.0000, "estimated_amount": 2280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2280.28, "standard_charge_percentage": 80.0000, "estimated_amount": 2280, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1161.23, "standard_charge_percentage": 42.0000, "estimated_amount": 1161, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2850.35, "estimated_amount": 2850, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1995.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1995, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2850.35, "estimated_amount": 2850, "methodology": "case rate" }]}]} , { "description": "Hc Translum Peripheral Atherectomy Abdom Aorta", "code_information": [ { "code": "0236T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47711.8, "discounted_cash": 16083,"minimum": 1551,"maximum": 45326.2,"payers_information":[{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 33398.3, "standard_charge_percentage": 70.0000, "estimated_amount": 33398, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 23855.9, "standard_charge_percentage": 50.0000, "estimated_amount": 23855, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 19437.8, "standard_charge_percentage": 42.0000, "estimated_amount": 19437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 28627.1, "standard_charge_percentage": 60.0000, "estimated_amount": 28627, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10737.3, "estimated_amount": 10737, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 41747.8, "standard_charge_percentage": 87.5000, "estimated_amount": 41747, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 13188.7, "estimated_amount": 13188, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 19437.8, "standard_charge_percentage": 42.0000, "estimated_amount": 19437, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 19838.6, "standard_charge_percentage": 42.0000, "estimated_amount": 19838, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6917, "estimated_amount": 6917, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 45326.2, "standard_charge_percentage": 95.0000, "estimated_amount": 45326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 12619.5, "estimated_amount": 12619, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 23855.9, "standard_charge_percentage": 50.0000, "estimated_amount": 23855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 20039, "standard_charge_percentage": 42.0000, "estimated_amount": 20038, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 42940.6, "standard_charge_percentage": 90.0000, "estimated_amount": 42940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 8714.14, "estimated_amount": 8714, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 14313.5, "standard_charge_percentage": 30.0000, "estimated_amount": 14313, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 16937.7, "standard_charge_percentage": 35.5000, "estimated_amount": 16937, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 40555, "standard_charge_percentage": 85.0000, "estimated_amount": 40555, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 8714.14, "estimated_amount": 8714, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 19437.8, "standard_charge_percentage": 42.0000, "estimated_amount": 19437, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 17051.2, "estimated_amount": 17051, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 20039, "standard_charge_percentage": 42.0000, "estimated_amount": 20038, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 12619.5, "estimated_amount": 12619, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 19037, "standard_charge_percentage": 42.0000, "estimated_amount": 19037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 42940.6, "standard_charge_percentage": 90.0000, "estimated_amount": 42940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 10998.8, "estimated_amount": 10998, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 35783.8, "standard_charge_percentage": 75.0000, "estimated_amount": 35783, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 33398.3, "standard_charge_percentage": 70.0000, "estimated_amount": 33398, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 42940.6, "standard_charge_percentage": 90.0000, "estimated_amount": 42940, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1551, "estimated_amount": 1551, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 19037, "standard_charge_percentage": 42.0000, "estimated_amount": 19037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17320.9, "estimated_amount": 17320, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 33398.3, "standard_charge_percentage": 70.0000, "estimated_amount": 33398, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 12990.7, "estimated_amount": 12990, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 38169.4, "standard_charge_percentage": 80.0000, "estimated_amount": 38169, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 19437.8, "standard_charge_percentage": 42.0000, "estimated_amount": 19437, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Translum Peripherl Atherectomy Brachiocephal Ea", "code_information": [ { "code": "0237T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52552.3, "discounted_cash": 16083,"minimum": 1551,"maximum": 49924.7,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 20968.4, "standard_charge_percentage": 42.0000, "estimated_amount": 20968, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 36786.6, "standard_charge_percentage": 70.0000, "estimated_amount": 36786, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 47297.1, "standard_charge_percentage": 90.0000, "estimated_amount": 47297, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 42041.8, "standard_charge_percentage": 80.0000, "estimated_amount": 42041, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 42041.8, "standard_charge_percentage": 80.0000, "estimated_amount": 42041, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1551, "estimated_amount": 1551, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 22072, "standard_charge_percentage": 42.0000, "estimated_amount": 22071, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 36786.6, "standard_charge_percentage": 70.0000, "estimated_amount": 36786, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 26276.2, "standard_charge_percentage": 50.0000, "estimated_amount": 26276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 18656.1, "standard_charge_percentage": 35.5000, "estimated_amount": 18656, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 49924.7, "standard_charge_percentage": 95.0000, "estimated_amount": 49924, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 12619.5, "estimated_amount": 12619, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 44669.5, "standard_charge_percentage": 85.0000, "estimated_amount": 44669, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 42041.8, "standard_charge_percentage": 80.0000, "estimated_amount": 42041, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 21409.8, "standard_charge_percentage": 42.0000, "estimated_amount": 21409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 13188.7, "estimated_amount": 13188, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 8714.14, "estimated_amount": 8714, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 31531.4, "standard_charge_percentage": 60.0000, "estimated_amount": 31531, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 8714.14, "estimated_amount": 8714, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 36786.6, "standard_charge_percentage": 70.0000, "estimated_amount": 36786, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 12619.5, "estimated_amount": 12619, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 39414.2, "standard_charge_percentage": 75.0000, "estimated_amount": 39414, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 42041.8, "standard_charge_percentage": 80.0000, "estimated_amount": 42041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 12990.7, "estimated_amount": 12990, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 21851.3, "standard_charge_percentage": 42.0000, "estimated_amount": 21851, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 21409.8, "standard_charge_percentage": 42.0000, "estimated_amount": 21409, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6917, "estimated_amount": 6917, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 10737.3, "estimated_amount": 10737, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 20968.4, "standard_charge_percentage": 42.0000, "estimated_amount": 20968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 10998.8, "estimated_amount": 10998, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 42041.8, "standard_charge_percentage": 80.0000, "estimated_amount": 42041, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 26276.2, "standard_charge_percentage": 50.0000, "estimated_amount": 26276, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 42041.8, "standard_charge_percentage": 80.0000, "estimated_amount": 42041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 21409.8, "standard_charge_percentage": 42.0000, "estimated_amount": 21409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 42041.8, "standard_charge_percentage": 80.0000, "estimated_amount": 42041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 45983.3, "standard_charge_percentage": 87.5000, "estimated_amount": 45983, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 12372.1, "estimated_amount": 12372, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 21409.8, "standard_charge_percentage": 42.0000, "estimated_amount": 21409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 42041.8, "standard_charge_percentage": 80.0000, "estimated_amount": 42041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 17320.9, "estimated_amount": 17320, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 17051.2, "estimated_amount": 17051, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 47297.1, "standard_charge_percentage": 90.0000, "estimated_amount": 47297, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 47297.1, "standard_charge_percentage": 90.0000, "estimated_amount": 47297, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 22072, "standard_charge_percentage": 42.0000, "estimated_amount": 22071, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 42041.8, "standard_charge_percentage": 80.0000, "estimated_amount": 42041, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 42041.8, "standard_charge_percentage": 80.0000, "estimated_amount": 42041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 15765.7, "standard_charge_percentage": 30.0000, "estimated_amount": 15765, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 12145.2, "estimated_amount": 12145, "methodology": "fee schedule" }]}]} , { "description": "Trluml perip athrc iliac art", "code_information": [ { "code": "0238T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53324, "discounted_cash": 25467,"minimum": 1551,"maximum": 50657.8,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 19590.1, "estimated_amount": 19590, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 16442, "estimated_amount": 16442, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 42659.2, "standard_charge_percentage": 80.0000, "estimated_amount": 42659, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 42659.2, "standard_charge_percentage": 80.0000, "estimated_amount": 42659, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 45325.4, "standard_charge_percentage": 85.0000, "estimated_amount": 45325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 8714.14, "estimated_amount": 8714, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 19590.1, "estimated_amount": 19590, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 15997.2, "standard_charge_percentage": 30.0000, "estimated_amount": 15997, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1551, "estimated_amount": 1551, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 19590.1, "estimated_amount": 19590, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 19590.1, "estimated_amount": 19590, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 21276.3, "standard_charge_percentage": 42.0000, "estimated_amount": 21276, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 21724.2, "standard_charge_percentage": 42.0000, "estimated_amount": 21724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 20883, "estimated_amount": 20883, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 27426.1, "estimated_amount": 27426, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 21724.2, "standard_charge_percentage": 42.0000, "estimated_amount": 21724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 20569.6, "estimated_amount": 20569, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 19590.1, "estimated_amount": 19590, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 22396.1, "standard_charge_percentage": 42.0000, "estimated_amount": 22396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 8714.14, "estimated_amount": 8714, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 22172.1, "standard_charge_percentage": 42.0000, "estimated_amount": 22172, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 21724.2, "standard_charge_percentage": 42.0000, "estimated_amount": 21724, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 26662, "standard_charge_percentage": 50.0000, "estimated_amount": 26662, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 42659.2, "standard_charge_percentage": 80.0000, "estimated_amount": 42659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 42659.2, "standard_charge_percentage": 80.0000, "estimated_amount": 42659, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 50657.8, "standard_charge_percentage": 95.0000, "estimated_amount": 50657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 19590.1, "estimated_amount": 19590, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 17415.6, "estimated_amount": 17415, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 46658.5, "standard_charge_percentage": 87.5000, "estimated_amount": 46658, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 42659.2, "standard_charge_percentage": 80.0000, "estimated_amount": 42659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 19590.1, "estimated_amount": 19590, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 26662, "standard_charge_percentage": 50.0000, "estimated_amount": 26662, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6917, "estimated_amount": 6917, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 47991.6, "standard_charge_percentage": 90.0000, "estimated_amount": 47991, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 19981.9, "estimated_amount": 19981, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 12876.6, "estimated_amount": 12876, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 47991.6, "standard_charge_percentage": 90.0000, "estimated_amount": 47991, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 42659.2, "standard_charge_percentage": 80.0000, "estimated_amount": 42659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 37326.8, "standard_charge_percentage": 70.0000, "estimated_amount": 37326, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 19590.1, "estimated_amount": 19590, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 26110.4, "estimated_amount": 26110, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 42659.2, "standard_charge_percentage": 80.0000, "estimated_amount": 42659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 31994.4, "standard_charge_percentage": 60.0000, "estimated_amount": 31994, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 42659.2, "standard_charge_percentage": 80.0000, "estimated_amount": 42659, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 37326.8, "standard_charge_percentage": 70.0000, "estimated_amount": 37326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 18930, "standard_charge_percentage": 35.5000, "estimated_amount": 18930, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 42659.2, "standard_charge_percentage": 80.0000, "estimated_amount": 42659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 19590.1, "estimated_amount": 19590, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 37326.8, "standard_charge_percentage": 70.0000, "estimated_amount": 37326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 19981.9, "estimated_amount": 19981, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 21724.2, "standard_charge_percentage": 42.0000, "estimated_amount": 21724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 19590.1, "estimated_amount": 19590, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 21276.3, "standard_charge_percentage": 42.0000, "estimated_amount": 21276, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 47991.6, "standard_charge_percentage": 90.0000, "estimated_amount": 47991, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 39993, "standard_charge_percentage": 75.0000, "estimated_amount": 39993, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 42659.2, "standard_charge_percentage": 80.0000, "estimated_amount": 42659, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 22396.1, "standard_charge_percentage": 42.0000, "estimated_amount": 22396, "methodology": "percent of total billed charges" }]}]} , { "description": "Nfct ds vir resp rna 4 trgt ", "code_information": [ { "code": "0241U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 713.15, "discounted_cash": 185,"minimum": 108.28,"maximum": 677.49,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 213.94, "standard_charge_percentage": 30.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 126.8, "estimated_amount": 126, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 427.89, "standard_charge_percentage": 60.0000, "estimated_amount": 427, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 477.81, "standard_charge_percentage": 67.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 641.84, "standard_charge_percentage": 90.0000, "estimated_amount": 641, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 348.23, "standard_charge_percentage": 48.8300, "estimated_amount": 348, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 145.48, "estimated_amount": 145, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 199.68, "estimated_amount": 199, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 641.84, "standard_charge_percentage": 90.0000, "estimated_amount": 641, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 148.26, "standard_charge_percentage": 21.0000, "estimated_amount": 148, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 145.27, "standard_charge_percentage": 21.0000, "estimated_amount": 145, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 624.01, "standard_charge_percentage": 87.5000, "estimated_amount": 624, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 145.27, "standard_charge_percentage": 21.0000, "estimated_amount": 145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 108.28, "estimated_amount": 108, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 677.49, "standard_charge_percentage": 95.0000, "estimated_amount": 677, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 152.04, "estimated_amount": 152, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 499.2, "standard_charge_percentage": 70.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 427.89, "standard_charge_percentage": 60.0000, "estimated_amount": 427, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 145.27, "standard_charge_percentage": 21.0000, "estimated_amount": 145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 499.2, "standard_charge_percentage": 70.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 253.17, "standard_charge_percentage": 35.5000, "estimated_amount": 253, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 145.48, "estimated_amount": 145, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 356.57, "standard_charge_percentage": 50.0000, "estimated_amount": 356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 534.86, "standard_charge_percentage": 75.0000, "estimated_amount": 534, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 180.28, "standard_charge_percentage": 25.2800, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 570.52, "standard_charge_percentage": 80.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 142.27, "standard_charge_percentage": 21.0000, "estimated_amount": 142, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 356.57, "standard_charge_percentage": 50.0000, "estimated_amount": 356, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 641.84, "standard_charge_percentage": 90.0000, "estimated_amount": 641, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 499.2, "standard_charge_percentage": 70.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 149.76, "standard_charge_percentage": 21.0000, "estimated_amount": 149, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 606.18, "standard_charge_percentage": 85.0000, "estimated_amount": 606, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 427.89, "standard_charge_percentage": 60.0000, "estimated_amount": 427, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 145.27, "standard_charge_percentage": 21.0000, "estimated_amount": 145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 142.27, "standard_charge_percentage": 21.0000, "estimated_amount": 142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 142.63, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 149.76, "estimated_amount": 149, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 166.81, "standard_charge_percentage": 23.3900, "estimated_amount": 166, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 149.76, "standard_charge_percentage": 21.0000, "estimated_amount": 149, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Perc Lamino-/Laminectomy Indir Imag Guide Lumbar", "code_information": [ { "code": "0275T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24846.3, "discounted_cash": 10131,"minimum": 996.34,"maximum": 23604,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 19877, "standard_charge_percentage": 80.0000, "estimated_amount": 19877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 10122.4, "standard_charge_percentage": 42.0000, "estimated_amount": 10122, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 19877, "standard_charge_percentage": 80.0000, "estimated_amount": 19877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 19877, "standard_charge_percentage": 80.0000, "estimated_amount": 19877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 10122.4, "standard_charge_percentage": 42.0000, "estimated_amount": 10122, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 22361.7, "standard_charge_percentage": 90.0000, "estimated_amount": 22361, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 19877, "standard_charge_percentage": 80.0000, "estimated_amount": 19877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 21740.5, "standard_charge_percentage": 87.5000, "estimated_amount": 21740, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 10122.4, "standard_charge_percentage": 42.0000, "estimated_amount": 10122, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 10122.4, "standard_charge_percentage": 42.0000, "estimated_amount": 10122, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 10435.5, "standard_charge_percentage": 42.0000, "estimated_amount": 10435, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 10331.1, "standard_charge_percentage": 42.0000, "estimated_amount": 10331, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 22361.7, "standard_charge_percentage": 90.0000, "estimated_amount": 22361, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 19877, "standard_charge_percentage": 80.0000, "estimated_amount": 19877, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 8879.54, "estimated_amount": 8879, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 10435.5, "standard_charge_percentage": 42.0000, "estimated_amount": 10435, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 19877, "standard_charge_percentage": 80.0000, "estimated_amount": 19877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 9913.67, "standard_charge_percentage": 42.0000, "estimated_amount": 9913, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 21119.3, "standard_charge_percentage": 85.0000, "estimated_amount": 21119, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 18634.7, "standard_charge_percentage": 75.0000, "estimated_amount": 18634, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 14907.8, "standard_charge_percentage": 60.0000, "estimated_amount": 14907, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 8307.89, "estimated_amount": 8307, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 6928.44, "estimated_amount": 6928, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 23604, "standard_charge_percentage": 95.0000, "estimated_amount": 23603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 19877, "standard_charge_percentage": 80.0000, "estimated_amount": 19877, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 19877, "standard_charge_percentage": 80.0000, "estimated_amount": 19877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 17392.4, "standard_charge_percentage": 70.0000, "estimated_amount": 17392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 8183.2, "estimated_amount": 8183, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7453.89, "standard_charge_percentage": 30.0000, "estimated_amount": 7453, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 22361.7, "standard_charge_percentage": 90.0000, "estimated_amount": 22361, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1383, "estimated_amount": 1383, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 12423.2, "standard_charge_percentage": 50.0000, "estimated_amount": 12423, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 17392.4, "standard_charge_percentage": 70.0000, "estimated_amount": 17392, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 19877, "standard_charge_percentage": 80.0000, "estimated_amount": 19877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10910.9, "estimated_amount": 10910, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 19877, "standard_charge_percentage": 80.0000, "estimated_amount": 19877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 12423.2, "standard_charge_percentage": 50.0000, "estimated_amount": 12423, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 5591.55, "estimated_amount": 5591, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 9913.67, "standard_charge_percentage": 42.0000, "estimated_amount": 9913, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 996.34, "estimated_amount": 996, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6315, "estimated_amount": 6315, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 17392.4, "standard_charge_percentage": 70.0000, "estimated_amount": 17392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" }]}]} , { "description": "Hc Myocrd Sympathetic Innervaj Img Plnr Qual&Quant", "code_information": [ { "code": "0331T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5542.3, "discounted_cash": 1851,"minimum": 714,"maximum": 5265.19,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4988.07, "standard_charge_percentage": 90.0000, "estimated_amount": 4988, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 714, "estimated_amount": 714, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4710.95, "standard_charge_percentage": 85.0000, "estimated_amount": 4710, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2771.15, "standard_charge_percentage": 50.0000, "estimated_amount": 2771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4156.73, "standard_charge_percentage": 75.0000, "estimated_amount": 4156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4849.51, "standard_charge_percentage": 87.5000, "estimated_amount": 4849, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4988.07, "standard_charge_percentage": 90.0000, "estimated_amount": 4988, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3879.61, "standard_charge_percentage": 70.0000, "estimated_amount": 3879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1105.69, "standard_charge_percentage": 21.0000, "estimated_amount": 1105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1128.97, "standard_charge_percentage": 21.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1152.24, "standard_charge_percentage": 21.0000, "estimated_amount": 1152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1993.91, "estimated_amount": 1993, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5265.19, "standard_charge_percentage": 95.0000, "estimated_amount": 5265, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1662.69, "standard_charge_percentage": 30.0000, "estimated_amount": 1662, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4988.07, "standard_charge_percentage": 90.0000, "estimated_amount": 4988, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1247.27, "estimated_amount": 1247, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1128.97, "standard_charge_percentage": 21.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1163.88, "standard_charge_percentage": 21.0000, "estimated_amount": 1163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1128.97, "standard_charge_percentage": 21.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1980.7, "estimated_amount": 1980, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 2771.15, "standard_charge_percentage": 50.0000, "estimated_amount": 2771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1163.88, "standard_charge_percentage": 21.0000, "estimated_amount": 1163, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3879.61, "standard_charge_percentage": 70.0000, "estimated_amount": 3879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1452.7, "estimated_amount": 1452, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1495.43, "estimated_amount": 1495, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1128.97, "standard_charge_percentage": 21.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1105.69, "standard_charge_percentage": 21.0000, "estimated_amount": 1105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1452.7, "estimated_amount": 1452, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3325.38, "standard_charge_percentage": 60.0000, "estimated_amount": 3325, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3879.61, "standard_charge_percentage": 70.0000, "estimated_amount": 3879, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Myocrd Symp Innervaj Img Plnr Qual&Quant W/Spect", "code_information": [ { "code": "0332T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5542.3, "discounted_cash": 1851,"minimum": 714,"maximum": 5265.19,"payers_information":[{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1152.24, "standard_charge_percentage": 21.0000, "estimated_amount": 1152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5265.19, "standard_charge_percentage": 95.0000, "estimated_amount": 5265, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1495.43, "estimated_amount": 1495, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2771.15, "standard_charge_percentage": 50.0000, "estimated_amount": 2771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 714, "estimated_amount": 714, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4988.07, "standard_charge_percentage": 90.0000, "estimated_amount": 4988, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4710.95, "standard_charge_percentage": 85.0000, "estimated_amount": 4710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1105.69, "standard_charge_percentage": 21.0000, "estimated_amount": 1105, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 2771.15, "standard_charge_percentage": 50.0000, "estimated_amount": 2771, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4988.07, "standard_charge_percentage": 90.0000, "estimated_amount": 4988, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1163.88, "standard_charge_percentage": 21.0000, "estimated_amount": 1163, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1128.97, "standard_charge_percentage": 21.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4156.73, "standard_charge_percentage": 75.0000, "estimated_amount": 4156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1452.7, "estimated_amount": 1452, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1662.69, "standard_charge_percentage": 30.0000, "estimated_amount": 1662, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4849.51, "standard_charge_percentage": 87.5000, "estimated_amount": 4849, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1993.91, "estimated_amount": 1993, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1105.69, "standard_charge_percentage": 21.0000, "estimated_amount": 1105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3879.61, "standard_charge_percentage": 70.0000, "estimated_amount": 3879, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4988.07, "standard_charge_percentage": 90.0000, "estimated_amount": 4988, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1980.7, "estimated_amount": 1980, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1128.97, "standard_charge_percentage": 21.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1163.88, "standard_charge_percentage": 21.0000, "estimated_amount": 1163, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3879.61, "standard_charge_percentage": 70.0000, "estimated_amount": 3879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3325.38, "standard_charge_percentage": 60.0000, "estimated_amount": 3325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1424.22, "estimated_amount": 1424, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1128.97, "standard_charge_percentage": 21.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1247.27, "estimated_amount": 1247, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1452.7, "estimated_amount": 1452, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4433.84, "standard_charge_percentage": 80.0000, "estimated_amount": 4433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3879.61, "standard_charge_percentage": 70.0000, "estimated_amount": 3879, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1128.97, "standard_charge_percentage": 21.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "0335T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11026.1, "discounted_cash": 10131,"minimum": 1216,"maximum": 10910.9,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4630.95, "standard_charge_percentage": 42.0000, "estimated_amount": 4630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 8820.86, "standard_charge_percentage": 80.0000, "estimated_amount": 8820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 7718.26, "standard_charge_percentage": 70.0000, "estimated_amount": 7718, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10910.9, "estimated_amount": 10910, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 8820.86, "standard_charge_percentage": 80.0000, "estimated_amount": 8820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6615.65, "standard_charge_percentage": 60.0000, "estimated_amount": 6615, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 7718.26, "standard_charge_percentage": 70.0000, "estimated_amount": 7718, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 8820.86, "standard_charge_percentage": 80.0000, "estimated_amount": 8820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8820.86, "standard_charge_percentage": 80.0000, "estimated_amount": 8820, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 8820.86, "standard_charge_percentage": 80.0000, "estimated_amount": 8820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 5513.04, "standard_charge_percentage": 50.0000, "estimated_amount": 5513, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 10474.8, "standard_charge_percentage": 95.0000, "estimated_amount": 10474, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4492.02, "standard_charge_percentage": 42.0000, "estimated_amount": 4492, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5513.04, "standard_charge_percentage": 50.0000, "estimated_amount": 5513, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 9923.47, "standard_charge_percentage": 90.0000, "estimated_amount": 9923, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 9923.47, "standard_charge_percentage": 90.0000, "estimated_amount": 9923, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 4399.41, "standard_charge_percentage": 42.0000, "estimated_amount": 4399, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 8820.86, "standard_charge_percentage": 80.0000, "estimated_amount": 8820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 8269.56, "standard_charge_percentage": 75.0000, "estimated_amount": 8269, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 4399.41, "standard_charge_percentage": 42.0000, "estimated_amount": 4399, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4492.02, "standard_charge_percentage": 42.0000, "estimated_amount": 4492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 8820.86, "standard_charge_percentage": 80.0000, "estimated_amount": 8820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4584.64, "standard_charge_percentage": 42.0000, "estimated_amount": 4584, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2695.58, "estimated_amount": 2695, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4540.39, "estimated_amount": 4540, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 8183.2, "estimated_amount": 8183, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4630.95, "standard_charge_percentage": 42.0000, "estimated_amount": 4630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 9923.47, "standard_charge_percentage": 90.0000, "estimated_amount": 9923, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3307.82, "standard_charge_percentage": 30.0000, "estimated_amount": 3307, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4492.02, "standard_charge_percentage": 42.0000, "estimated_amount": 4492, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 9647.82, "standard_charge_percentage": 87.5000, "estimated_amount": 9647, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 8820.86, "standard_charge_percentage": 80.0000, "estimated_amount": 8820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 7718.26, "standard_charge_percentage": 70.0000, "estimated_amount": 7718, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8820.86, "standard_charge_percentage": 80.0000, "estimated_amount": 8820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 9372.17, "standard_charge_percentage": 85.0000, "estimated_amount": 9372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 8820.86, "standard_charge_percentage": 80.0000, "estimated_amount": 8820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4492.02, "standard_charge_percentage": 42.0000, "estimated_amount": 4492, "methodology": "percent of total billed charges" }]}]} , { "description": "Waterjet prostate abltj cmpl", "code_information": [ { "code": "0421T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7230.06, "discounted_cash": 13114,"minimum": 1329,"maximum": 7230.06,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5784.05, "standard_charge_percentage": 80.0000, "estimated_amount": 5784, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3006.26, "standard_charge_percentage": 42.0000, "estimated_amount": 3006, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1329, "estimated_amount": 1329, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5784.05, "standard_charge_percentage": 80.0000, "estimated_amount": 5784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 3615.03, "standard_charge_percentage": 50.0000, "estimated_amount": 3615, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5784.05, "standard_charge_percentage": 80.0000, "estimated_amount": 5784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2169.02, "standard_charge_percentage": 30.0000, "estimated_amount": 2169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5784.05, "standard_charge_percentage": 80.0000, "estimated_amount": 5784, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2945.53, "standard_charge_percentage": 42.0000, "estimated_amount": 2945, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5784.05, "standard_charge_percentage": 80.0000, "estimated_amount": 5784, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5979, "estimated_amount": 5979, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6507.05, "standard_charge_percentage": 90.0000, "estimated_amount": 6507, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 7230.06, "estimated_amount": 9628, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6145.55, "standard_charge_percentage": 85.0000, "estimated_amount": 6145, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5784.05, "standard_charge_percentage": 80.0000, "estimated_amount": 5784, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3036.63, "standard_charge_percentage": 42.0000, "estimated_amount": 3036, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6326.3, "standard_charge_percentage": 87.5000, "estimated_amount": 6326, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3615.03, "standard_charge_percentage": 50.0000, "estimated_amount": 3615, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5784.05, "standard_charge_percentage": 80.0000, "estimated_amount": 5784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2945.53, "standard_charge_percentage": 42.0000, "estimated_amount": 2945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5784.05, "standard_charge_percentage": 80.0000, "estimated_amount": 5784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5061.04, "standard_charge_percentage": 70.0000, "estimated_amount": 5061, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 7230.06, "estimated_amount": 15857, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2884.79, "standard_charge_percentage": 42.0000, "estimated_amount": 2884, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6507.05, "standard_charge_percentage": 90.0000, "estimated_amount": 6507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4338.04, "standard_charge_percentage": 60.0000, "estimated_amount": 4338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5061.04, "standard_charge_percentage": 70.0000, "estimated_amount": 5061, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5784.05, "standard_charge_percentage": 80.0000, "estimated_amount": 5784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2945.53, "standard_charge_percentage": 42.0000, "estimated_amount": 2945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5422.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5422, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7230.06, "estimated_amount": 10088, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6868.56, "standard_charge_percentage": 95.0000, "estimated_amount": 6868, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7230.06, "estimated_amount": 7230, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5061.04, "standard_charge_percentage": 70.0000, "estimated_amount": 5061, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5784.05, "standard_charge_percentage": 80.0000, "estimated_amount": 5784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3036.63, "standard_charge_percentage": 42.0000, "estimated_amount": 3036, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2945.53, "standard_charge_percentage": 42.0000, "estimated_amount": 2945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2884.79, "standard_charge_percentage": 42.0000, "estimated_amount": 2884, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6507.05, "standard_charge_percentage": 90.0000, "estimated_amount": 6507, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Ntrapx C Ffr W/3D Funcjl Map", "code_information": [ { "code": "0523T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9948.45,"minimum": 38.6,"maximum": 9451.03,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7958.76, "standard_charge_percentage": 80.0000, "estimated_amount": 7958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1984.72, "standard_charge_percentage": 21.0000, "estimated_amount": 1984, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2984.53, "standard_charge_percentage": 30.0000, "estimated_amount": 2984, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6963.91, "standard_charge_percentage": 70.0000, "estimated_amount": 6963, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 8953.61, "standard_charge_percentage": 90.0000, "estimated_amount": 8953, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2026.5, "standard_charge_percentage": 21.0000, "estimated_amount": 2026, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2068.28, "standard_charge_percentage": 21.0000, "estimated_amount": 2068, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 7958.76, "standard_charge_percentage": 80.0000, "estimated_amount": 7958, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 8704.89, "standard_charge_percentage": 87.5000, "estimated_amount": 8704, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2026.5, "standard_charge_percentage": 21.0000, "estimated_amount": 2026, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 8953.61, "standard_charge_percentage": 90.0000, "estimated_amount": 8953, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 7958.76, "standard_charge_percentage": 80.0000, "estimated_amount": 7958, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2089.17, "standard_charge_percentage": 21.0000, "estimated_amount": 2089, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 38.6, "estimated_amount": 38, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6963.91, "standard_charge_percentage": 70.0000, "estimated_amount": 6963, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 7958.76, "standard_charge_percentage": 80.0000, "estimated_amount": 7958, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2026.5, "standard_charge_percentage": 21.0000, "estimated_amount": 2026, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 8953.61, "standard_charge_percentage": 90.0000, "estimated_amount": 8953, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2089.17, "standard_charge_percentage": 21.0000, "estimated_amount": 2089, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 4974.23, "standard_charge_percentage": 50.0000, "estimated_amount": 4974, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4974.23, "standard_charge_percentage": 50.0000, "estimated_amount": 4974, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6963.91, "standard_charge_percentage": 70.0000, "estimated_amount": 6963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 7461.34, "standard_charge_percentage": 75.0000, "estimated_amount": 7461, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1984.72, "standard_charge_percentage": 21.0000, "estimated_amount": 1984, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 7958.76, "standard_charge_percentage": 80.0000, "estimated_amount": 7958, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 7958.76, "standard_charge_percentage": 80.0000, "estimated_amount": 7958, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2026.5, "standard_charge_percentage": 21.0000, "estimated_amount": 2026, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 61.29, "estimated_amount": 61, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 8456.18, "standard_charge_percentage": 85.0000, "estimated_amount": 8456, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 7958.76, "standard_charge_percentage": 80.0000, "estimated_amount": 7958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7958.76, "standard_charge_percentage": 80.0000, "estimated_amount": 7958, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 7958.76, "standard_charge_percentage": 80.0000, "estimated_amount": 7958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5969.07, "standard_charge_percentage": 60.0000, "estimated_amount": 5969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 7958.76, "standard_charge_percentage": 80.0000, "estimated_amount": 7958, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 9451.03, "standard_charge_percentage": 95.0000, "estimated_amount": 9451, "methodology": "percent of total billed charges" }]}]} , { "description": "FNA BX US GUIDANCE 1ST LESION", "code_information": [ { "code": "10005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 997,"minimum": 576.46,"maximum": 2896.7,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1155.78, "standard_charge_percentage": 42.0000, "estimated_amount": 1155, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2896.7, "estimated_amount": 2896, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 761.79, "estimated_amount": 761, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2027.69, "standard_charge_percentage": 70.0000, "estimated_amount": 2027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1448.35, "standard_charge_percentage": 50.0000, "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1155.78, "standard_charge_percentage": 42.0000, "estimated_amount": 1155, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1098.02, "estimated_amount": 1098, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1738.02, "standard_charge_percentage": 60.0000, "estimated_amount": 1738, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 651.88, "estimated_amount": 651, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2027.69, "standard_charge_percentage": 70.0000, "estimated_amount": 2027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1448.35, "standard_charge_percentage": 50.0000, "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2607.03, "standard_charge_percentage": 90.0000, "estimated_amount": 2607, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 761.79, "estimated_amount": 761, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1216.61, "standard_charge_percentage": 42.0000, "estimated_amount": 1216, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2027.69, "standard_charge_percentage": 70.0000, "estimated_amount": 2027, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2172.53, "standard_charge_percentage": 75.0000, "estimated_amount": 2172, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2534.61, "standard_charge_percentage": 87.5000, "estimated_amount": 2534, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 869.01, "standard_charge_percentage": 30.0000, "estimated_amount": 869, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2751.86, "standard_charge_percentage": 95.0000, "estimated_amount": 2751, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2607.03, "standard_charge_percentage": 90.0000, "estimated_amount": 2607, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2607.03, "standard_charge_percentage": 90.0000, "estimated_amount": 2607, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1204.45, "standard_charge_percentage": 42.0000, "estimated_amount": 1204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1414.46, "standard_charge_percentage": 48.8300, "estimated_amount": 1414, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2462.19, "standard_charge_percentage": 85.0000, "estimated_amount": 2462, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1216.61, "standard_charge_percentage": 42.0000, "estimated_amount": 1216, "methodology": "percent of total billed charges" }]}]} , { "description": "FNA BX US GDN EA ADDL LESION", "code_information": [ { "code": "10006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1598.55,"minimum": 282,"maximum": 1598.55,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1278.84, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1438.69, "standard_charge_percentage": 90.0000, "estimated_amount": 1438, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1598.55, "estimated_amount": 1598, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 671.39, "standard_charge_percentage": 42.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 671.39, "standard_charge_percentage": 42.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 664.68, "standard_charge_percentage": 42.0000, "estimated_amount": 664, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1438.69, "standard_charge_percentage": 90.0000, "estimated_amount": 1438, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 479.56, "standard_charge_percentage": 30.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1278.84, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1398.73, "standard_charge_percentage": 87.5000, "estimated_amount": 1398, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1278.84, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1278.84, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 651.25, "standard_charge_percentage": 42.0000, "estimated_amount": 651, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 637.82, "standard_charge_percentage": 42.0000, "estimated_amount": 637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1198.91, "standard_charge_percentage": 75.0000, "estimated_amount": 1198, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1358.77, "standard_charge_percentage": 85.0000, "estimated_amount": 1358, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1518.62, "standard_charge_percentage": 95.0000, "estimated_amount": 1518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1278.84, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1118.98, "standard_charge_percentage": 70.0000, "estimated_amount": 1118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 637.82, "standard_charge_percentage": 42.0000, "estimated_amount": 637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1278.84, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1118.98, "standard_charge_percentage": 70.0000, "estimated_amount": 1118, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1278.84, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1278.84, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 959.13, "standard_charge_percentage": 60.0000, "estimated_amount": 959, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1438.69, "standard_charge_percentage": 90.0000, "estimated_amount": 1438, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 651.25, "standard_charge_percentage": 42.0000, "estimated_amount": 651, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 651.25, "standard_charge_percentage": 42.0000, "estimated_amount": 651, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 799.27, "standard_charge_percentage": 50.0000, "estimated_amount": 799, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1118.98, "standard_charge_percentage": 70.0000, "estimated_amount": 1118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 799.27, "standard_charge_percentage": 50.0000, "estimated_amount": 799, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 651.25, "standard_charge_percentage": 42.0000, "estimated_amount": 651, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1278.84, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1278.84, "standard_charge_percentage": 80.0000, "estimated_amount": 1278, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Fine Needle Aspiration Bx W/Fluor Gdn 1St Lesion", "code_information": [ { "code": "10007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 997,"minimum": 256.86,"maximum": 2896.7,"payers_information":[{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2027.69, "standard_charge_percentage": 70.0000, "estimated_amount": 2027, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2607.03, "standard_charge_percentage": 90.0000, "estimated_amount": 2607, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2896.7, "estimated_amount": 2896, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2607.03, "standard_charge_percentage": 90.0000, "estimated_amount": 2607, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 432.65, "estimated_amount": 432, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1155.78, "standard_charge_percentage": 42.0000, "estimated_amount": 1155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1216.61, "standard_charge_percentage": 42.0000, "estimated_amount": 1216, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2607.03, "standard_charge_percentage": 90.0000, "estimated_amount": 2607, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1448.35, "standard_charge_percentage": 50.0000, "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2534.61, "standard_charge_percentage": 87.5000, "estimated_amount": 2534, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 869.01, "standard_charge_percentage": 30.0000, "estimated_amount": 869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2462.19, "standard_charge_percentage": 85.0000, "estimated_amount": 2462, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2172.53, "standard_charge_percentage": 75.0000, "estimated_amount": 2172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2751.86, "standard_charge_percentage": 95.0000, "estimated_amount": 2751, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1448.35, "standard_charge_percentage": 50.0000, "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1216.61, "standard_charge_percentage": 42.0000, "estimated_amount": 1216, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2027.69, "standard_charge_percentage": 70.0000, "estimated_amount": 2027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2027.69, "standard_charge_percentage": 70.0000, "estimated_amount": 2027, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 256.86, "estimated_amount": 256, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 761.79, "estimated_amount": 761, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 761.79, "estimated_amount": 761, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1204.45, "standard_charge_percentage": 42.0000, "estimated_amount": 1204, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1155.78, "standard_charge_percentage": 42.0000, "estimated_amount": 1155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1738.02, "standard_charge_percentage": 60.0000, "estimated_amount": 1738, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1414.46, "standard_charge_percentage": 48.8300, "estimated_amount": 1414, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Fine Needle Aspiration Bx W/Fluor Gdn Ea Addl", "code_information": [ { "code": "10008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500,"minimum": 150,"maximum": 500,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 250, "standard_charge_percentage": 50.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 250, "standard_charge_percentage": 50.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 500, "estimated_amount": 500, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 207.9, "standard_charge_percentage": 42.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 375, "standard_charge_percentage": 75.0000, "estimated_amount": 375, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 437.5, "standard_charge_percentage": 87.5000, "estimated_amount": 437, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 300, "standard_charge_percentage": 60.0000, "estimated_amount": 300, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 210, "standard_charge_percentage": 42.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 210, "standard_charge_percentage": 42.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 500, "estimated_amount": 500, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150, "standard_charge_percentage": 30.0000, "estimated_amount": 150, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 425, "standard_charge_percentage": 85.0000, "estimated_amount": 425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 475, "standard_charge_percentage": 95.0000, "estimated_amount": 475, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 199.5, "standard_charge_percentage": 42.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 199.5, "standard_charge_percentage": 42.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" }]}]} , { "description": "FNA BX CT GUIDANCE 1ST LESION", "code_information": [ { "code": "10009", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 997,"minimum": 256.86,"maximum": 2896.7,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2751.86, "standard_charge_percentage": 95.0000, "estimated_amount": 2751, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2607.03, "standard_charge_percentage": 90.0000, "estimated_amount": 2607, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 761.79, "estimated_amount": 761, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1216.61, "standard_charge_percentage": 42.0000, "estimated_amount": 1216, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1448.35, "standard_charge_percentage": 50.0000, "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 761.79, "estimated_amount": 761, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1216.61, "standard_charge_percentage": 42.0000, "estimated_amount": 1216, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2027.69, "standard_charge_percentage": 70.0000, "estimated_amount": 2027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1155.78, "standard_charge_percentage": 42.0000, "estimated_amount": 1155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2027.69, "standard_charge_percentage": 70.0000, "estimated_amount": 2027, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2896.7, "estimated_amount": 2896, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2607.03, "standard_charge_percentage": 90.0000, "estimated_amount": 2607, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2027.69, "standard_charge_percentage": 70.0000, "estimated_amount": 2027, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2607.03, "standard_charge_percentage": 90.0000, "estimated_amount": 2607, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1448.35, "standard_charge_percentage": 50.0000, "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1155.78, "standard_charge_percentage": 42.0000, "estimated_amount": 1155, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2534.61, "standard_charge_percentage": 87.5000, "estimated_amount": 2534, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 432.65, "estimated_amount": 432, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 256.86, "estimated_amount": 256, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2462.19, "standard_charge_percentage": 85.0000, "estimated_amount": 2462, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 869.01, "standard_charge_percentage": 30.0000, "estimated_amount": 869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1738.02, "standard_charge_percentage": 60.0000, "estimated_amount": 1738, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2172.53, "standard_charge_percentage": 75.0000, "estimated_amount": 2172, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1204.45, "standard_charge_percentage": 42.0000, "estimated_amount": 1204, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1414.46, "standard_charge_percentage": 48.8300, "estimated_amount": 1414, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" }]}]} , { "description": "FNA BX CT GDN EA ADDL LESION", "code_information": [ { "code": "10010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500,"minimum": 150,"maximum": 500,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 500, "estimated_amount": 500, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 500, "estimated_amount": 500, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 425, "standard_charge_percentage": 85.0000, "estimated_amount": 425, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 210, "standard_charge_percentage": 42.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 475, "standard_charge_percentage": 95.0000, "estimated_amount": 475, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 250, "standard_charge_percentage": 50.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 207.9, "standard_charge_percentage": 42.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 250, "standard_charge_percentage": 50.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 199.5, "standard_charge_percentage": 42.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 210, "standard_charge_percentage": 42.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150, "standard_charge_percentage": 30.0000, "estimated_amount": 150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 199.5, "standard_charge_percentage": 42.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 437.5, "standard_charge_percentage": 87.5000, "estimated_amount": 437, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 375, "standard_charge_percentage": 75.0000, "estimated_amount": 375, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 300, "standard_charge_percentage": 60.0000, "estimated_amount": 300, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Fine Needle Aspiration Bx W/Mr Gdn 1St Lesion", "code_information": [ { "code": "10011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 997,"minimum": 256.86,"maximum": 2896.7,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1448.35, "standard_charge_percentage": 50.0000, "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2896.7, "estimated_amount": 2896, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1448.35, "standard_charge_percentage": 50.0000, "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2534.61, "standard_charge_percentage": 87.5000, "estimated_amount": 2534, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2607.03, "standard_charge_percentage": 90.0000, "estimated_amount": 2607, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 869.01, "standard_charge_percentage": 30.0000, "estimated_amount": 869, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1216.61, "standard_charge_percentage": 42.0000, "estimated_amount": 1216, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 761.79, "estimated_amount": 761, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2027.69, "standard_charge_percentage": 70.0000, "estimated_amount": 2027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1155.78, "standard_charge_percentage": 42.0000, "estimated_amount": 1155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1216.61, "standard_charge_percentage": 42.0000, "estimated_amount": 1216, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 432.65, "estimated_amount": 432, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1738.02, "standard_charge_percentage": 60.0000, "estimated_amount": 1738, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 256.86, "estimated_amount": 256, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 761.79, "estimated_amount": 761, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1414.46, "standard_charge_percentage": 48.8300, "estimated_amount": 1414, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1204.45, "standard_charge_percentage": 42.0000, "estimated_amount": 1204, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2027.69, "standard_charge_percentage": 70.0000, "estimated_amount": 2027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1155.78, "standard_charge_percentage": 42.0000, "estimated_amount": 1155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2607.03, "standard_charge_percentage": 90.0000, "estimated_amount": 2607, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2172.53, "standard_charge_percentage": 75.0000, "estimated_amount": 2172, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1180.12, "standard_charge_percentage": 42.0000, "estimated_amount": 1180, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2751.86, "standard_charge_percentage": 95.0000, "estimated_amount": 2751, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2462.19, "standard_charge_percentage": 85.0000, "estimated_amount": 2462, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2317.36, "standard_charge_percentage": 80.0000, "estimated_amount": 2317, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2607.03, "standard_charge_percentage": 90.0000, "estimated_amount": 2607, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2027.69, "standard_charge_percentage": 70.0000, "estimated_amount": 2027, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Fine Needle Aspiration Bx W/Mr Gdn Ea Addl", "code_information": [ { "code": "10012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500,"minimum": 150,"maximum": 500,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 210, "standard_charge_percentage": 42.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 437.5, "standard_charge_percentage": 87.5000, "estimated_amount": 437, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 375, "standard_charge_percentage": 75.0000, "estimated_amount": 375, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 250, "standard_charge_percentage": 50.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 500, "estimated_amount": 500, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 425, "standard_charge_percentage": 85.0000, "estimated_amount": 425, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 250, "standard_charge_percentage": 50.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 210, "standard_charge_percentage": 42.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 199.5, "standard_charge_percentage": 42.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 500, "estimated_amount": 500, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 199.5, "standard_charge_percentage": 42.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 207.9, "standard_charge_percentage": 42.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 475, "standard_charge_percentage": 95.0000, "estimated_amount": 475, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 300, "standard_charge_percentage": 60.0000, "estimated_amount": 300, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150, "standard_charge_percentage": 30.0000, "estimated_amount": 150, "methodology": "percent of total billed charges" }]}]} , { "description": "ENDOVENOUS RF VEIN ADD-ON", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1127.75, "discounted_cash": 566,"minimum": 112.04,"maximum": 1127.75,"payers_information":[{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 473.65, "standard_charge_percentage": 42.0000, "estimated_amount": 473, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 468.92, "standard_charge_percentage": 42.0000, "estimated_amount": 468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 449.97, "standard_charge_percentage": 42.0000, "estimated_amount": 449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1014.98, "standard_charge_percentage": 90.0000, "estimated_amount": 1014, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 789.42, "standard_charge_percentage": 70.0000, "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 459.45, "standard_charge_percentage": 42.0000, "estimated_amount": 459, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 563.88, "standard_charge_percentage": 50.0000, "estimated_amount": 563, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1127.75, "estimated_amount": 1127, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 845.81, "standard_charge_percentage": 75.0000, "estimated_amount": 845, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 459.45, "standard_charge_percentage": 42.0000, "estimated_amount": 459, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1071.36, "standard_charge_percentage": 95.0000, "estimated_amount": 1071, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 134.6, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 473.65, "standard_charge_percentage": 42.0000, "estimated_amount": 473, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1014.98, "standard_charge_percentage": 90.0000, "estimated_amount": 1014, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 789.42, "standard_charge_percentage": 70.0000, "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 459.45, "standard_charge_percentage": 42.0000, "estimated_amount": 459, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 676.65, "standard_charge_percentage": 60.0000, "estimated_amount": 676, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 958.59, "standard_charge_percentage": 85.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 789.42, "standard_charge_percentage": 70.0000, "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 338.32, "standard_charge_percentage": 30.0000, "estimated_amount": 338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1127.75, "estimated_amount": 1127, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1014.98, "standard_charge_percentage": 90.0000, "estimated_amount": 1014, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 134.6, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 550.68, "standard_charge_percentage": 48.8300, "estimated_amount": 550, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 459.45, "standard_charge_percentage": 42.0000, "estimated_amount": 459, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 986.78, "standard_charge_percentage": 87.5000, "estimated_amount": 986, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 449.97, "standard_charge_percentage": 42.0000, "estimated_amount": 449, "methodology": "percent of total billed charges" }]}]} , { "description": "INS ENDOVAS VENA CAVA FILTR", "code_information": [ { "code": "10030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 997,"minimum": 112.04,"maximum": 4474.4,"payers_information":[{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 206.48, "estimated_amount": 206, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 206.48, "estimated_amount": 206, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" }]}]} , { "description": "Acne surgery", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.15, "discounted_cash": 281,"minimum": 59.05,"maximum": 589.15,"payers_information":[{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 235.07, "standard_charge_percentage": 42.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 176.75, "standard_charge_percentage": 30.0000, "estimated_amount": 176, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 559.69, "standard_charge_percentage": 95.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 353.49, "standard_charge_percentage": 60.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 247.44, "standard_charge_percentage": 42.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 244.97, "standard_charge_percentage": 42.0000, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 235.07, "standard_charge_percentage": 42.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 500.78, "standard_charge_percentage": 85.0000, "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 294.57, "standard_charge_percentage": 50.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 515.51, "standard_charge_percentage": 87.5000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 247.44, "standard_charge_percentage": 42.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 441.86, "standard_charge_percentage": 75.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 59.05, "estimated_amount": 59, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" }]}]} , { "description": "I&d abscess simple/single", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6937.5, "discounted_cash": 281,"minimum": 112.04,"maximum": 6590.63,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 132.78, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5550, "standard_charge_percentage": 80.0000, "estimated_amount": 5550, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5550, "standard_charge_percentage": 80.0000, "estimated_amount": 5550, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 866.7, "standard_charge_percentage": 90.0000, "estimated_amount": 866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 866.7, "standard_charge_percentage": 90.0000, "estimated_amount": 866, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 400.42, "standard_charge_percentage": 42.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 404.46, "standard_charge_percentage": 42.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4856.25, "standard_charge_percentage": 70.0000, "estimated_amount": 4856, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2826.34, "standard_charge_percentage": 42.0000, "estimated_amount": 2826, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 722.25, "standard_charge_percentage": 75.0000, "estimated_amount": 722, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5896.88, "standard_charge_percentage": 85.0000, "estimated_amount": 5896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 132.78, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 384.24, "standard_charge_percentage": 42.0000, "estimated_amount": 384, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 577.8, "standard_charge_percentage": 60.0000, "estimated_amount": 577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2768.06, "standard_charge_percentage": 42.0000, "estimated_amount": 2768, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6243.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6243, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 866.7, "standard_charge_percentage": 90.0000, "estimated_amount": 866, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2884.61, "standard_charge_percentage": 42.0000, "estimated_amount": 2884, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3468.75, "standard_charge_percentage": 50.0000, "estimated_amount": 3468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 132.78, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6243.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6243, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4856.25, "standard_charge_percentage": 70.0000, "estimated_amount": 4856, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2081.25, "standard_charge_percentage": 30.0000, "estimated_amount": 2081, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 384.24, "standard_charge_percentage": 42.0000, "estimated_amount": 384, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 288.9, "standard_charge_percentage": 30.0000, "estimated_amount": 288, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 392.33, "standard_charge_percentage": 42.0000, "estimated_amount": 392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4162.5, "standard_charge_percentage": 60.0000, "estimated_amount": 4162, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5550, "standard_charge_percentage": 80.0000, "estimated_amount": 5550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2768.06, "standard_charge_percentage": 42.0000, "estimated_amount": 2768, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 392.33, "standard_charge_percentage": 42.0000, "estimated_amount": 392, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 914.85, "standard_charge_percentage": 95.0000, "estimated_amount": 914, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2826.34, "standard_charge_percentage": 42.0000, "estimated_amount": 2826, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5550, "standard_charge_percentage": 80.0000, "estimated_amount": 5550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 963, "estimated_amount": 963, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3387.58, "standard_charge_percentage": 48.8300, "estimated_amount": 3387, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2826.34, "standard_charge_percentage": 42.0000, "estimated_amount": 2826, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6243.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6243, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2913.75, "standard_charge_percentage": 42.0000, "estimated_amount": 2913, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 404.46, "standard_charge_percentage": 42.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5550, "standard_charge_percentage": 80.0000, "estimated_amount": 5550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 842.63, "standard_charge_percentage": 87.5000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2826.34, "standard_charge_percentage": 42.0000, "estimated_amount": 2826, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 963, "estimated_amount": 963, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4856.25, "standard_charge_percentage": 70.0000, "estimated_amount": 4856, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5550, "standard_charge_percentage": 80.0000, "estimated_amount": 5550, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5550, "standard_charge_percentage": 80.0000, "estimated_amount": 5550, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6070.31, "standard_charge_percentage": 87.5000, "estimated_amount": 6070, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 392.33, "standard_charge_percentage": 42.0000, "estimated_amount": 392, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 392.33, "standard_charge_percentage": 42.0000, "estimated_amount": 392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 470.23, "standard_charge_percentage": 48.8300, "estimated_amount": 470, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5550, "standard_charge_percentage": 80.0000, "estimated_amount": 5550, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 818.55, "standard_charge_percentage": 85.0000, "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6590.63, "standard_charge_percentage": 95.0000, "estimated_amount": 6590, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 674.1, "standard_charge_percentage": 70.0000, "estimated_amount": 674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 132.78, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5550, "standard_charge_percentage": 80.0000, "estimated_amount": 5550, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 481.5, "standard_charge_percentage": 50.0000, "estimated_amount": 481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2913.75, "standard_charge_percentage": 42.0000, "estimated_amount": 2913, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5203.13, "standard_charge_percentage": 75.0000, "estimated_amount": 5203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 674.1, "standard_charge_percentage": 70.0000, "estimated_amount": 674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 674.1, "standard_charge_percentage": 70.0000, "estimated_amount": 674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5550, "standard_charge_percentage": 80.0000, "estimated_amount": 5550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" }]}]} , { "description": "Hc Incision & Drain Skin Abscess Complic", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1217, "discounted_cash": 566,"minimum": 112.04,"maximum": 1217,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 132.78, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 506.03, "standard_charge_percentage": 42.0000, "estimated_amount": 506, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 730.2, "standard_charge_percentage": 60.0000, "estimated_amount": 730, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 495.81, "standard_charge_percentage": 42.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 511.14, "standard_charge_percentage": 42.0000, "estimated_amount": 511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 594.26, "standard_charge_percentage": 48.8300, "estimated_amount": 594, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 432.65, "estimated_amount": 432, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 485.58, "standard_charge_percentage": 42.0000, "estimated_amount": 485, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 511.14, "standard_charge_percentage": 42.0000, "estimated_amount": 511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1095.3, "standard_charge_percentage": 90.0000, "estimated_amount": 1095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 973, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 608.5, "standard_charge_percentage": 50.0000, "estimated_amount": 608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 912.75, "standard_charge_percentage": 75.0000, "estimated_amount": 912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 132.78, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 256.86, "estimated_amount": 256, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 851.9, "standard_charge_percentage": 70.0000, "estimated_amount": 851, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1034.45, "standard_charge_percentage": 85.0000, "estimated_amount": 1034, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1095.3, "standard_charge_percentage": 90.0000, "estimated_amount": 1095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 495.81, "standard_charge_percentage": 42.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1064.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1064, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 851.9, "standard_charge_percentage": 70.0000, "estimated_amount": 851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 485.58, "standard_charge_percentage": 42.0000, "estimated_amount": 485, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 973, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 495.81, "standard_charge_percentage": 42.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1217, "estimated_amount": 1217, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1217, "estimated_amount": 1217, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 365.1, "standard_charge_percentage": 30.0000, "estimated_amount": 365, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1156.15, "standard_charge_percentage": 95.0000, "estimated_amount": 1156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 495.81, "standard_charge_percentage": 42.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 851.9, "standard_charge_percentage": 70.0000, "estimated_amount": 851, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1095.3, "standard_charge_percentage": 90.0000, "estimated_amount": 1095, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 973, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Incision & Drain Pilonidal Cyst Simpl", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 963, "discounted_cash": 997,"minimum": 132.78,"maximum": 7303.13,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2306.25, "standard_charge_percentage": 30.0000, "estimated_amount": 2306, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 432.65, "estimated_amount": 432, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 866.7, "standard_charge_percentage": 90.0000, "estimated_amount": 866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 256.86, "estimated_amount": 256, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 132.78, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6726.56, "standard_charge_percentage": 87.5000, "estimated_amount": 6726, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 842.63, "standard_charge_percentage": 87.5000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 818.55, "standard_charge_percentage": 85.0000, "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3228.75, "standard_charge_percentage": 42.0000, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 384.24, "standard_charge_percentage": 42.0000, "estimated_amount": 384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6534.38, "standard_charge_percentage": 85.0000, "estimated_amount": 6534, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 481.5, "standard_charge_percentage": 50.0000, "estimated_amount": 481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3131.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5381.25, "standard_charge_percentage": 70.0000, "estimated_amount": 5381, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3131.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3131, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 674.1, "standard_charge_percentage": 70.0000, "estimated_amount": 674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5765.63, "standard_charge_percentage": 75.0000, "estimated_amount": 5765, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5381.25, "standard_charge_percentage": 70.0000, "estimated_amount": 5381, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3067.31, "standard_charge_percentage": 42.0000, "estimated_amount": 3067, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3131.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 470.23, "standard_charge_percentage": 48.8300, "estimated_amount": 470, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3753.81, "standard_charge_percentage": 48.8300, "estimated_amount": 3753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 866.7, "standard_charge_percentage": 90.0000, "estimated_amount": 866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 722.25, "standard_charge_percentage": 75.0000, "estimated_amount": 722, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 404.46, "standard_charge_percentage": 42.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3228.75, "standard_charge_percentage": 42.0000, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 866.7, "standard_charge_percentage": 90.0000, "estimated_amount": 866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 132.78, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5381.25, "standard_charge_percentage": 70.0000, "estimated_amount": 5381, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 384.24, "standard_charge_percentage": 42.0000, "estimated_amount": 384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 963, "estimated_amount": 963, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 400.42, "standard_charge_percentage": 42.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 963, "estimated_amount": 963, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 288.9, "standard_charge_percentage": 30.0000, "estimated_amount": 288, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6918.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6918, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 392.33, "standard_charge_percentage": 42.0000, "estimated_amount": 392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6918.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 256.86, "estimated_amount": 256, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 404.46, "standard_charge_percentage": 42.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 674.1, "standard_charge_percentage": 70.0000, "estimated_amount": 674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3131.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 392.33, "standard_charge_percentage": 42.0000, "estimated_amount": 392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6918.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 392.33, "standard_charge_percentage": 42.0000, "estimated_amount": 392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 577.8, "standard_charge_percentage": 60.0000, "estimated_amount": 577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 132.78, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7303.13, "standard_charge_percentage": 95.0000, "estimated_amount": 7303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3067.31, "standard_charge_percentage": 42.0000, "estimated_amount": 3067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 132.78, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 674.1, "standard_charge_percentage": 70.0000, "estimated_amount": 674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4612.5, "standard_charge_percentage": 60.0000, "estimated_amount": 4612, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3196.46, "standard_charge_percentage": 42.0000, "estimated_amount": 3196, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 392.33, "standard_charge_percentage": 42.0000, "estimated_amount": 392, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 432.65, "estimated_amount": 432, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 770.4, "standard_charge_percentage": 80.0000, "estimated_amount": 770, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 914.85, "standard_charge_percentage": 95.0000, "estimated_amount": 914, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 963, "estimated_amount": 963, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3843.75, "standard_charge_percentage": 50.0000, "estimated_amount": 3843, "methodology": "percent of total billed charges" }]}]} , { "description": "RMVL TUNNLED CV CATH W/PORT", "code_information": [ { "code": "10081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5094, "discounted_cash": 997,"minimum": 519.96,"maximum": 4839.3,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4839.3, "standard_charge_percentage": 95.0000, "estimated_amount": 4839, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1183.68, "estimated_amount": 1183, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3565.8, "standard_charge_percentage": 70.0000, "estimated_amount": 3565, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2487.4, "standard_charge_percentage": 48.8300, "estimated_amount": 2487, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1528.2, "standard_charge_percentage": 30.0000, "estimated_amount": 1528, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2139.48, "standard_charge_percentage": 42.0000, "estimated_amount": 2139, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4329.9, "standard_charge_percentage": 85.0000, "estimated_amount": 4329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2075.3, "standard_charge_percentage": 42.0000, "estimated_amount": 2075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2075.3, "standard_charge_percentage": 42.0000, "estimated_amount": 2075, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1183.68, "estimated_amount": 1183, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2032.51, "standard_charge_percentage": 42.0000, "estimated_amount": 2032, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2118.09, "standard_charge_percentage": 42.0000, "estimated_amount": 2118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2032.51, "standard_charge_percentage": 42.0000, "estimated_amount": 2032, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3820.5, "standard_charge_percentage": 75.0000, "estimated_amount": 3820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4457.25, "standard_charge_percentage": 87.5000, "estimated_amount": 4457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3565.8, "standard_charge_percentage": 70.0000, "estimated_amount": 3565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2139.48, "standard_charge_percentage": 42.0000, "estimated_amount": 2139, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4584.6, "standard_charge_percentage": 90.0000, "estimated_amount": 4584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2075.3, "standard_charge_percentage": 42.0000, "estimated_amount": 2075, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4584.6, "standard_charge_percentage": 90.0000, "estimated_amount": 4584, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3565.8, "standard_charge_percentage": 70.0000, "estimated_amount": 3565, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4584.6, "standard_charge_percentage": 90.0000, "estimated_amount": 4584, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2075.3, "standard_charge_percentage": 42.0000, "estimated_amount": 2075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2547, "standard_charge_percentage": 50.0000, "estimated_amount": 2547, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3056.4, "standard_charge_percentage": 60.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" }]}]} , { "description": "Inc&rmvl fb subq tiss smpl", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1658, "discounted_cash": 566,"minimum": 112.04,"maximum": 6234.38,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1326.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 256.45, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1160.6, "standard_charge_percentage": 70.0000, "estimated_amount": 1160, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 689.4, "standard_charge_percentage": 42.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1326.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 661.54, "standard_charge_percentage": 42.0000, "estimated_amount": 661, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 829, "standard_charge_percentage": 50.0000, "estimated_amount": 829, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1492.2, "standard_charge_percentage": 90.0000, "estimated_amount": 1492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1243.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1243, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 809.6, "standard_charge_percentage": 48.8300, "estimated_amount": 809, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 256.45, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1326.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1575.1, "standard_charge_percentage": 95.0000, "estimated_amount": 1575, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1450.75, "standard_charge_percentage": 87.5000, "estimated_amount": 1450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 497.4, "standard_charge_percentage": 30.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 696.36, "standard_charge_percentage": 42.0000, "estimated_amount": 696, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 675.47, "standard_charge_percentage": 42.0000, "estimated_amount": 675, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1492.2, "standard_charge_percentage": 90.0000, "estimated_amount": 1492, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1409.3, "standard_charge_percentage": 85.0000, "estimated_amount": 1409, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 675.47, "standard_charge_percentage": 42.0000, "estimated_amount": 675, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1326.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1326.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1326.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1326.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1658, "estimated_amount": 1658, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 696.36, "standard_charge_percentage": 42.0000, "estimated_amount": 696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 256.45, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 675.47, "standard_charge_percentage": 42.0000, "estimated_amount": 675, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 675.47, "standard_charge_percentage": 42.0000, "estimated_amount": 675, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 994.8, "standard_charge_percentage": 60.0000, "estimated_amount": 994, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1160.6, "standard_charge_percentage": 70.0000, "estimated_amount": 1160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1326.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1160.6, "standard_charge_percentage": 70.0000, "estimated_amount": 1160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 661.54, "standard_charge_percentage": 42.0000, "estimated_amount": 661, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1326.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1492.2, "standard_charge_percentage": 90.0000, "estimated_amount": 1492, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1326.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 256.45, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Remove Foreign Body Complex", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6913, "discounted_cash": 2297,"minimum": 519.96,"maximum": 6567.35,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2758.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2903.46, "standard_charge_percentage": 42.0000, "estimated_amount": 2903, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4839.1, "standard_charge_percentage": 70.0000, "estimated_amount": 4839, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5530, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6221.7, "standard_charge_percentage": 90.0000, "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2874.43, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4147.8, "standard_charge_percentage": 60.0000, "estimated_amount": 4147, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5530, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2816.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2816, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6221.7, "standard_charge_percentage": 90.0000, "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2758.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6221.7, "standard_charge_percentage": 90.0000, "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3375.62, "standard_charge_percentage": 48.8300, "estimated_amount": 3375, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4839.1, "standard_charge_percentage": 70.0000, "estimated_amount": 4839, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5876.05, "standard_charge_percentage": 85.0000, "estimated_amount": 5876, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4839.1, "standard_charge_percentage": 70.0000, "estimated_amount": 4839, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2816.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2816, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5530, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2903.46, "standard_charge_percentage": 42.0000, "estimated_amount": 2903, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6567.35, "standard_charge_percentage": 95.0000, "estimated_amount": 6567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2073.9, "standard_charge_percentage": 30.0000, "estimated_amount": 2073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2816.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2816, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2816.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2816, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5184.75, "standard_charge_percentage": 75.0000, "estimated_amount": 5184, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5530, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3456.5, "standard_charge_percentage": 50.0000, "estimated_amount": 3456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5530, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6048.88, "standard_charge_percentage": 87.5000, "estimated_amount": 6048, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" }]}]} , { "description": "I&d hmtma seromafluid collj", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5094, "discounted_cash": 2297,"minimum": 519.96,"maximum": 6768.75,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2118.09, "standard_charge_percentage": 42.0000, "estimated_amount": 2118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3056.4, "standard_charge_percentage": 60.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4457.25, "standard_charge_percentage": 87.5000, "estimated_amount": 4457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3565.8, "standard_charge_percentage": 70.0000, "estimated_amount": 3565, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3562.5, "standard_charge_percentage": 50.0000, "estimated_amount": 3562, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4584.6, "standard_charge_percentage": 90.0000, "estimated_amount": 4584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2992.5, "standard_charge_percentage": 42.0000, "estimated_amount": 2992, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2902.72, "standard_charge_percentage": 42.0000, "estimated_amount": 2902, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6412.5, "standard_charge_percentage": 90.0000, "estimated_amount": 6412, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2842.88, "standard_charge_percentage": 42.0000, "estimated_amount": 2842, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2075.3, "standard_charge_percentage": 42.0000, "estimated_amount": 2075, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2547, "standard_charge_percentage": 50.0000, "estimated_amount": 2547, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2075.3, "standard_charge_percentage": 42.0000, "estimated_amount": 2075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1528.2, "standard_charge_percentage": 30.0000, "estimated_amount": 1528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2487.4, "standard_charge_percentage": 48.8300, "estimated_amount": 2487, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1183.68, "estimated_amount": 1183, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4987.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4987, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4584.6, "standard_charge_percentage": 90.0000, "estimated_amount": 4584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2032.51, "standard_charge_percentage": 42.0000, "estimated_amount": 2032, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6056.25, "standard_charge_percentage": 85.0000, "estimated_amount": 6056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3565.8, "standard_charge_percentage": 70.0000, "estimated_amount": 3565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2139.48, "standard_charge_percentage": 42.0000, "estimated_amount": 2139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1183.68, "estimated_amount": 1183, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4987.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4987, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3565.8, "standard_charge_percentage": 70.0000, "estimated_amount": 3565, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2032.51, "standard_charge_percentage": 42.0000, "estimated_amount": 2032, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2137.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4275, "standard_charge_percentage": 60.0000, "estimated_amount": 4275, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6412.5, "standard_charge_percentage": 90.0000, "estimated_amount": 6412, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2075.3, "standard_charge_percentage": 42.0000, "estimated_amount": 2075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5343.75, "standard_charge_percentage": 75.0000, "estimated_amount": 5343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2902.72, "standard_charge_percentage": 42.0000, "estimated_amount": 2902, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6412.5, "standard_charge_percentage": 90.0000, "estimated_amount": 6412, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2902.72, "standard_charge_percentage": 42.0000, "estimated_amount": 2902, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2902.72, "standard_charge_percentage": 42.0000, "estimated_amount": 2902, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5094, "estimated_amount": 5094, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 87.5000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4329.9, "standard_charge_percentage": 85.0000, "estimated_amount": 4329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4987.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4987, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6768.75, "standard_charge_percentage": 95.0000, "estimated_amount": 6768, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3479.14, "standard_charge_percentage": 48.8300, "estimated_amount": 3479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2992.5, "standard_charge_percentage": 42.0000, "estimated_amount": 2992, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4839.3, "standard_charge_percentage": 95.0000, "estimated_amount": 4839, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1183.68, "estimated_amount": 1183, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2962.57, "standard_charge_percentage": 42.0000, "estimated_amount": 2962, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3820.5, "standard_charge_percentage": 75.0000, "estimated_amount": 3820, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4584.6, "standard_charge_percentage": 90.0000, "estimated_amount": 4584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1183.68, "estimated_amount": 1183, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2139.48, "standard_charge_percentage": 42.0000, "estimated_amount": 2139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2075.3, "standard_charge_percentage": 42.0000, "estimated_amount": 2075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2842.88, "standard_charge_percentage": 42.0000, "estimated_amount": 2842, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4075.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4075, "methodology": "percent of total billed charges" }]}]} , { "description": "EXC BEN LES SC/NK/H/F0.6-1.0CM", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 327.6, "discounted_cash": 566,"minimum": 98.28,"maximum": 327.6,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 133.46, "standard_charge_percentage": 42.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 130.71, "standard_charge_percentage": 42.0000, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 262.08, "standard_charge_percentage": 80.0000, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 294.84, "standard_charge_percentage": 90.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 229.32, "standard_charge_percentage": 70.0000, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 137.59, "standard_charge_percentage": 42.0000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 136.22, "standard_charge_percentage": 42.0000, "estimated_amount": 136, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 133.46, "standard_charge_percentage": 42.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 229.32, "standard_charge_percentage": 70.0000, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 262.08, "standard_charge_percentage": 80.0000, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 98.28, "standard_charge_percentage": 30.0000, "estimated_amount": 98, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 262.08, "standard_charge_percentage": 80.0000, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 196.56, "standard_charge_percentage": 60.0000, "estimated_amount": 196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 245.7, "standard_charge_percentage": 75.0000, "estimated_amount": 245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 262.08, "standard_charge_percentage": 80.0000, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 262.08, "standard_charge_percentage": 80.0000, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 262.08, "standard_charge_percentage": 80.0000, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 229.32, "standard_charge_percentage": 70.0000, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 286.65, "standard_charge_percentage": 87.5000, "estimated_amount": 286, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 133.46, "standard_charge_percentage": 42.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 256.86, "estimated_amount": 256, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 262.08, "standard_charge_percentage": 80.0000, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 294.84, "standard_charge_percentage": 90.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 132.78, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 133.46, "standard_charge_percentage": 42.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 294.84, "standard_charge_percentage": 90.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 130.71, "standard_charge_percentage": 42.0000, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 278.46, "standard_charge_percentage": 85.0000, "estimated_amount": 278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 132.78, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 262.08, "standard_charge_percentage": 80.0000, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 137.59, "standard_charge_percentage": 42.0000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 163.8, "standard_charge_percentage": 50.0000, "estimated_amount": 163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 262.08, "standard_charge_percentage": 80.0000, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 159.97, "standard_charge_percentage": 48.8300, "estimated_amount": 159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 327.6, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 311.22, "standard_charge_percentage": 95.0000, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 262.08, "standard_charge_percentage": 80.0000, "estimated_amount": 262, "methodology": "percent of total billed charges" }]}]} , { "description": "I&d complex po wound infctj", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9465, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 8991.75,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 7572, "standard_charge_percentage": 80.0000, "estimated_amount": 7572, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3975.3, "standard_charge_percentage": 42.0000, "estimated_amount": 3975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 7098.75, "standard_charge_percentage": 75.0000, "estimated_amount": 7098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3975.3, "standard_charge_percentage": 42.0000, "estimated_amount": 3975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 8518.5, "standard_charge_percentage": 90.0000, "estimated_amount": 8518, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3856.04, "standard_charge_percentage": 42.0000, "estimated_amount": 3856, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5679, "standard_charge_percentage": 60.0000, "estimated_amount": 5679, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6625.5, "standard_charge_percentage": 70.0000, "estimated_amount": 6625, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 8991.75, "standard_charge_percentage": 95.0000, "estimated_amount": 8991, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 8045.25, "standard_charge_percentage": 85.0000, "estimated_amount": 8045, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 8518.5, "standard_charge_percentage": 90.0000, "estimated_amount": 8518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1821.98, "estimated_amount": 1821, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 7572, "standard_charge_percentage": 80.0000, "estimated_amount": 7572, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 7572, "standard_charge_percentage": 80.0000, "estimated_amount": 7572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3856.04, "standard_charge_percentage": 42.0000, "estimated_amount": 3856, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 7572, "standard_charge_percentage": 80.0000, "estimated_amount": 7572, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3935.55, "standard_charge_percentage": 42.0000, "estimated_amount": 3935, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3776.53, "standard_charge_percentage": 42.0000, "estimated_amount": 3776, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3856.04, "standard_charge_percentage": 42.0000, "estimated_amount": 3856, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1821.98, "estimated_amount": 1821, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 7572, "standard_charge_percentage": 80.0000, "estimated_amount": 7572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 8518.5, "standard_charge_percentage": 90.0000, "estimated_amount": 8518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 7572, "standard_charge_percentage": 80.0000, "estimated_amount": 7572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 7572, "standard_charge_percentage": 80.0000, "estimated_amount": 7572, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4732.5, "standard_charge_percentage": 50.0000, "estimated_amount": 4732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 8281.88, "standard_charge_percentage": 87.5000, "estimated_amount": 8281, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6625.5, "standard_charge_percentage": 70.0000, "estimated_amount": 6625, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6625.5, "standard_charge_percentage": 70.0000, "estimated_amount": 6625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3856.04, "standard_charge_percentage": 42.0000, "estimated_amount": 3856, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7572, "standard_charge_percentage": 80.0000, "estimated_amount": 7572, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2839.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2839, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7572, "standard_charge_percentage": 80.0000, "estimated_amount": 7572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3776.53, "standard_charge_percentage": 42.0000, "estimated_amount": 3776, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 4621.76, "standard_charge_percentage": 48.8300, "estimated_amount": 4621, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 7572, "standard_charge_percentage": 80.0000, "estimated_amount": 7572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" }]}]} , { "description": "Dbrdmt eczinfected skin<10%", "code_information": [ { "code": "11000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 868,"minimum": 112.04,"maximum": 1201,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 142.57, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 142.57, "estimated_amount": 142, "methodology": "fee schedule" }]}]} , { "description": "UNLISTED PROC NERVOUS SYSTEM", "code_information": [ { "code": "11001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201,"minimum": 77.81,"maximum": 1201,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" }]}]} , { "description": "CHEMICAL PLEURODESIS", "code_information": [ { "code": "11004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2520.8,"minimum": 756.24,"maximum": 2520.8,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2268.72, "standard_charge_percentage": 90.0000, "estimated_amount": 2268, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2520.8, "estimated_amount": 2520, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1058.74, "standard_charge_percentage": 42.0000, "estimated_amount": 1058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1890.6, "standard_charge_percentage": 75.0000, "estimated_amount": 1890, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2268.72, "standard_charge_percentage": 90.0000, "estimated_amount": 2268, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2520.8, "estimated_amount": 2520, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1512.48, "standard_charge_percentage": 60.0000, "estimated_amount": 1512, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2205.7, "standard_charge_percentage": 87.5000, "estimated_amount": 2205, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1048.15, "standard_charge_percentage": 42.0000, "estimated_amount": 1048, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2520.8, "estimated_amount": 2520, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1005.8, "standard_charge_percentage": 42.0000, "estimated_amount": 1005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1764.56, "standard_charge_percentage": 70.0000, "estimated_amount": 1764, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1026.97, "standard_charge_percentage": 42.0000, "estimated_amount": 1026, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2394.76, "standard_charge_percentage": 95.0000, "estimated_amount": 2394, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1764.56, "standard_charge_percentage": 70.0000, "estimated_amount": 1764, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1260.4, "standard_charge_percentage": 50.0000, "estimated_amount": 1260, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2268.72, "standard_charge_percentage": 90.0000, "estimated_amount": 2268, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2142.68, "standard_charge_percentage": 85.0000, "estimated_amount": 2142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1764.56, "standard_charge_percentage": 70.0000, "estimated_amount": 1764, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1026.97, "standard_charge_percentage": 42.0000, "estimated_amount": 1026, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1026.97, "standard_charge_percentage": 42.0000, "estimated_amount": 1026, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1058.74, "standard_charge_percentage": 42.0000, "estimated_amount": 1058, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2520.8, "estimated_amount": 2520, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1005.8, "standard_charge_percentage": 42.0000, "estimated_amount": 1005, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1026.97, "standard_charge_percentage": 42.0000, "estimated_amount": 1026, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1230.91, "standard_charge_percentage": 48.8300, "estimated_amount": 1230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 756.24, "standard_charge_percentage": 30.0000, "estimated_amount": 756, "methodology": "percent of total billed charges" }]}]} , { "description": "FINE NEEDLE ASPIRATION", "code_information": [ { "code": "11005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3251,"minimum": 975.3,"maximum": 3251,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2600.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2600.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2438.25, "standard_charge_percentage": 75.0000, "estimated_amount": 2438, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 975.3, "standard_charge_percentage": 30.0000, "estimated_amount": 975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2275.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2275, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2639, "estimated_amount": 2639, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2925.9, "standard_charge_percentage": 90.0000, "estimated_amount": 2925, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1625.5, "standard_charge_percentage": 50.0000, "estimated_amount": 1625, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 3251, "estimated_amount": 3251, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1324.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1324, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2275.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2275, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2600.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2275.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1365.42, "standard_charge_percentage": 42.0000, "estimated_amount": 1365, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1950.6, "standard_charge_percentage": 60.0000, "estimated_amount": 1950, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1324.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1297.15, "standard_charge_percentage": 42.0000, "estimated_amount": 1297, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2600.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1587.46, "standard_charge_percentage": 48.8300, "estimated_amount": 1587, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 3251, "estimated_amount": 3251, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2600.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2600.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2763.35, "standard_charge_percentage": 85.0000, "estimated_amount": 2763, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1365.42, "standard_charge_percentage": 42.0000, "estimated_amount": 1365, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1351.77, "standard_charge_percentage": 42.0000, "estimated_amount": 1351, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2600.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1297.15, "standard_charge_percentage": 42.0000, "estimated_amount": 1297, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3088.45, "standard_charge_percentage": 95.0000, "estimated_amount": 3088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2600.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1324.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1324, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2600.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2925.9, "standard_charge_percentage": 90.0000, "estimated_amount": 2925, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1324.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1324, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2844.63, "standard_charge_percentage": 87.5000, "estimated_amount": 2844, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3251, "estimated_amount": 3251, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2925.9, "standard_charge_percentage": 90.0000, "estimated_amount": 2925, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2600.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" }]}]} , { "description": "LYSIS PENIL CIRCUMCISION", "code_information": [ { "code": "11006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2520.8,"minimum": 756.24,"maximum": 2520.8,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1764.56, "standard_charge_percentage": 70.0000, "estimated_amount": 1764, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1026.97, "standard_charge_percentage": 42.0000, "estimated_amount": 1026, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 756.24, "standard_charge_percentage": 30.0000, "estimated_amount": 756, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1764.56, "standard_charge_percentage": 70.0000, "estimated_amount": 1764, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2394.76, "standard_charge_percentage": 95.0000, "estimated_amount": 2394, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1026.97, "standard_charge_percentage": 42.0000, "estimated_amount": 1026, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2520.8, "estimated_amount": 2520, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1005.8, "standard_charge_percentage": 42.0000, "estimated_amount": 1005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1230.91, "standard_charge_percentage": 48.8300, "estimated_amount": 1230, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1260.4, "standard_charge_percentage": 50.0000, "estimated_amount": 1260, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1764.56, "standard_charge_percentage": 70.0000, "estimated_amount": 1764, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2142.68, "standard_charge_percentage": 85.0000, "estimated_amount": 2142, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2268.72, "standard_charge_percentage": 90.0000, "estimated_amount": 2268, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2268.72, "standard_charge_percentage": 90.0000, "estimated_amount": 2268, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1048.15, "standard_charge_percentage": 42.0000, "estimated_amount": 1048, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2520.8, "estimated_amount": 2520, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1058.74, "standard_charge_percentage": 42.0000, "estimated_amount": 1058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1512.48, "standard_charge_percentage": 60.0000, "estimated_amount": 1512, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2520.8, "estimated_amount": 2520, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2268.72, "standard_charge_percentage": 90.0000, "estimated_amount": 2268, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1058.74, "standard_charge_percentage": 42.0000, "estimated_amount": 1058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1005.8, "standard_charge_percentage": 42.0000, "estimated_amount": 1005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 2520.8, "estimated_amount": 2520, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1026.97, "standard_charge_percentage": 42.0000, "estimated_amount": 1026, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2016.64, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2205.7, "standard_charge_percentage": 87.5000, "estimated_amount": 2205, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1890.6, "standard_charge_percentage": 75.0000, "estimated_amount": 1890, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1026.97, "standard_charge_percentage": 42.0000, "estimated_amount": 1026, "methodology": "percent of total billed charges" }]}]} , { "description": "REPAIR OF CIRCUMCISION", "code_information": [ { "code": "11008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4036.75,"minimum": 519.96,"maximum": 4036.75,"payers_information":[{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1695.43, "standard_charge_percentage": 42.0000, "estimated_amount": 1695, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1287, "estimated_amount": 1287, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3229.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1644.57, "standard_charge_percentage": 42.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3229.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3027.56, "standard_charge_percentage": 75.0000, "estimated_amount": 3027, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1695.43, "standard_charge_percentage": 42.0000, "estimated_amount": 1695, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4036.75, "estimated_amount": 4036, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4036.75, "estimated_amount": 4036, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2825.72, "standard_charge_percentage": 70.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1211.03, "standard_charge_percentage": 30.0000, "estimated_amount": 1211, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2018.38, "standard_charge_percentage": 50.0000, "estimated_amount": 2018, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2825.72, "standard_charge_percentage": 70.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3229.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1971.15, "standard_charge_percentage": 48.8300, "estimated_amount": 1971, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1610.66, "standard_charge_percentage": 42.0000, "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3229.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1644.57, "standard_charge_percentage": 42.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3229.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3229.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1644.57, "standard_charge_percentage": 42.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3229.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1644.57, "standard_charge_percentage": 42.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 3532.16, "standard_charge_percentage": 87.5000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3834.91, "standard_charge_percentage": 95.0000, "estimated_amount": 3834, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2825.72, "standard_charge_percentage": 70.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 3633.07, "standard_charge_percentage": 90.0000, "estimated_amount": 3633, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 4036.75, "estimated_amount": 4036, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3229.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 3633.07, "standard_charge_percentage": 90.0000, "estimated_amount": 3633, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2422.05, "standard_charge_percentage": 60.0000, "estimated_amount": 2422, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3229.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1610.66, "standard_charge_percentage": 42.0000, "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 3431.24, "standard_charge_percentage": 85.0000, "estimated_amount": 3431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1678.48, "standard_charge_percentage": 42.0000, "estimated_amount": 1678, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 3633.07, "standard_charge_percentage": 90.0000, "estimated_amount": 3633, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3229.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3229, "methodology": "percent of total billed charges" }]}]} , { "description": "UNLISTED PROC NERVOUS SYSTEM", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 997,"minimum": 256.43,"maximum": 4474.4,"payers_information":[{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" }]}]} , { "description": "Dbrdmt subq tis 1st 20sqcm<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2214, "discounted_cash": 566,"minimum": 112.04,"maximum": 2214,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 929.88, "standard_charge_percentage": 42.0000, "estimated_amount": 929, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1992.6, "standard_charge_percentage": 90.0000, "estimated_amount": 1992, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2214, "estimated_amount": 2214, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1771.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1771.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 920.58, "standard_charge_percentage": 42.0000, "estimated_amount": 920, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1107, "standard_charge_percentage": 50.0000, "estimated_amount": 1107, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1771.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1992.6, "standard_charge_percentage": 90.0000, "estimated_amount": 1992, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1081.1, "standard_charge_percentage": 48.8300, "estimated_amount": 1081, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1771.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1881.9, "standard_charge_percentage": 85.0000, "estimated_amount": 1881, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1771.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 929.88, "standard_charge_percentage": 42.0000, "estimated_amount": 929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1771.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1660.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1660, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 901.98, "standard_charge_percentage": 42.0000, "estimated_amount": 901, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1771.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1771.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 901.98, "standard_charge_percentage": 42.0000, "estimated_amount": 901, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1549.8, "standard_charge_percentage": 70.0000, "estimated_amount": 1549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 256.45, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1771.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1549.8, "standard_charge_percentage": 70.0000, "estimated_amount": 1549, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1992.6, "standard_charge_percentage": 90.0000, "estimated_amount": 1992, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1549.8, "standard_charge_percentage": 70.0000, "estimated_amount": 1549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1328.4, "standard_charge_percentage": 60.0000, "estimated_amount": 1328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 883.39, "standard_charge_percentage": 42.0000, "estimated_amount": 883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1771.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1771, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 901.98, "standard_charge_percentage": 42.0000, "estimated_amount": 901, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1937.25, "standard_charge_percentage": 87.5000, "estimated_amount": 1937, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 256.45, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 883.39, "standard_charge_percentage": 42.0000, "estimated_amount": 883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 664.2, "standard_charge_percentage": 30.0000, "estimated_amount": 664, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2103.3, "standard_charge_percentage": 95.0000, "estimated_amount": 2103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 901.98, "standard_charge_percentage": 42.0000, "estimated_amount": 901, "methodology": "percent of total billed charges" }]}]} , { "description": "Dbrdmt musc&fsca 1st 20<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7125, "discounted_cash": 868,"minimum": 112.04,"maximum": 6768.75,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2342.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2342, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1192.87, "standard_charge_percentage": 42.0000, "estimated_amount": 1192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1756.8, "standard_charge_percentage": 60.0000, "estimated_amount": 1756, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6768.75, "standard_charge_percentage": 95.0000, "estimated_amount": 6768, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1229.76, "standard_charge_percentage": 42.0000, "estimated_amount": 1229, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2562, "standard_charge_percentage": 87.5000, "estimated_amount": 2562, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6412.5, "standard_charge_percentage": 90.0000, "estimated_amount": 6412, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1217.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2196, "standard_charge_percentage": 75.0000, "estimated_amount": 2196, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2902.72, "standard_charge_percentage": 42.0000, "estimated_amount": 2902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 256.45, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2342.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 256.45, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1192.87, "standard_charge_percentage": 42.0000, "estimated_amount": 1192, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6412.5, "standard_charge_percentage": 90.0000, "estimated_amount": 6412, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6056.25, "standard_charge_percentage": 85.0000, "estimated_amount": 6056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2635.2, "standard_charge_percentage": 90.0000, "estimated_amount": 2635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2902.72, "standard_charge_percentage": 42.0000, "estimated_amount": 2902, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1229.76, "standard_charge_percentage": 42.0000, "estimated_amount": 1229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 256.45, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4987.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4987, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2902.72, "standard_charge_percentage": 42.0000, "estimated_amount": 2902, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2635.2, "standard_charge_percentage": 90.0000, "estimated_amount": 2635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2049.6, "standard_charge_percentage": 70.0000, "estimated_amount": 2049, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2342.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1168.27, "standard_charge_percentage": 42.0000, "estimated_amount": 1168, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2635.2, "standard_charge_percentage": 90.0000, "estimated_amount": 2635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2962.57, "standard_charge_percentage": 42.0000, "estimated_amount": 2962, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2842.88, "standard_charge_percentage": 42.0000, "estimated_amount": 2842, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2992.5, "standard_charge_percentage": 42.0000, "estimated_amount": 2992, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2902.72, "standard_charge_percentage": 42.0000, "estimated_amount": 2902, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 95.0000, "estimated_amount": 2781, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4987.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4987, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2928, "estimated_amount": 2928, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2137.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2137, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2342.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2342, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1192.87, "standard_charge_percentage": 42.0000, "estimated_amount": 1192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1168.27, "standard_charge_percentage": 42.0000, "estimated_amount": 1168, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2342.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4987.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4987, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 87.5000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 256.45, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3562.5, "standard_charge_percentage": 50.0000, "estimated_amount": 3562, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6412.5, "standard_charge_percentage": 90.0000, "estimated_amount": 6412, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2992.5, "standard_charge_percentage": 42.0000, "estimated_amount": 2992, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2842.88, "standard_charge_percentage": 42.0000, "estimated_amount": 2842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3479.14, "standard_charge_percentage": 48.8300, "estimated_amount": 3479, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1192.87, "standard_charge_percentage": 42.0000, "estimated_amount": 1192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2342.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2342.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2342.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1429.74, "standard_charge_percentage": 48.8300, "estimated_amount": 1429, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1464, "standard_charge_percentage": 50.0000, "estimated_amount": 1464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5343.75, "standard_charge_percentage": 75.0000, "estimated_amount": 5343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5700, "standard_charge_percentage": 80.0000, "estimated_amount": 5700, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2049.6, "standard_charge_percentage": 70.0000, "estimated_amount": 2049, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4275, "standard_charge_percentage": 60.0000, "estimated_amount": 4275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2488.8, "standard_charge_percentage": 85.0000, "estimated_amount": 2488, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2049.6, "standard_charge_percentage": 70.0000, "estimated_amount": 2049, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2342.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2342.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 878.4, "standard_charge_percentage": 30.0000, "estimated_amount": 878, "methodology": "percent of total billed charges" }]}]} , { "description": "Dbrdmt bone 1st 20 sq cm<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3695, "discounted_cash": 2297,"minimum": 596,"maximum": 3695,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 3325.5, "standard_charge_percentage": 90.0000, "estimated_amount": 3325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 3325.5, "standard_charge_percentage": 90.0000, "estimated_amount": 3325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2586.5, "standard_charge_percentage": 70.0000, "estimated_amount": 2586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2771.25, "standard_charge_percentage": 75.0000, "estimated_amount": 2771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2956, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1474.31, "standard_charge_percentage": 42.0000, "estimated_amount": 1474, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1847.5, "standard_charge_percentage": 50.0000, "estimated_amount": 1847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1601.71, "estimated_amount": 1601, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2956, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1551.9, "standard_charge_percentage": 42.0000, "estimated_amount": 1551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2956, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1505.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 3325.5, "standard_charge_percentage": 90.0000, "estimated_amount": 3325, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1505.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2956, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2956, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2586.5, "standard_charge_percentage": 70.0000, "estimated_amount": 2586, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2956, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1474.31, "standard_charge_percentage": 42.0000, "estimated_amount": 1474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1505.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1505, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 3140.75, "standard_charge_percentage": 85.0000, "estimated_amount": 3140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1536.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3695, "estimated_amount": 3695, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2217, "standard_charge_percentage": 60.0000, "estimated_amount": 2217, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1601.71, "estimated_amount": 1601, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2956, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1804.27, "standard_charge_percentage": 48.8300, "estimated_amount": 1804, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1108.5, "standard_charge_percentage": 30.0000, "estimated_amount": 1108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1505.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1505, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2956, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2956, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1551.9, "standard_charge_percentage": 42.0000, "estimated_amount": 1551, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2956, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3510.25, "standard_charge_percentage": 95.0000, "estimated_amount": 3510, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 3233.13, "standard_charge_percentage": 87.5000, "estimated_amount": 3233, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2586.5, "standard_charge_percentage": 70.0000, "estimated_amount": 2586, "methodology": "percent of total billed charges" }]}]} , { "description": "DECLOT PORT W/ THROMB AGNT", "code_information": [ { "code": "11045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1076,"minimum": 256.72,"maximum": 1076,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 753.2, "standard_charge_percentage": 70.0000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1076, "estimated_amount": 1076, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 447.4, "standard_charge_percentage": 42.0000, "estimated_amount": 447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 753.2, "standard_charge_percentage": 70.0000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 429.32, "standard_charge_percentage": 42.0000, "estimated_amount": 429, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 438.36, "standard_charge_percentage": 42.0000, "estimated_amount": 438, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 256.72, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 941.5, "standard_charge_percentage": 87.5000, "estimated_amount": 941, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 322.8, "standard_charge_percentage": 30.0000, "estimated_amount": 322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 860.8, "standard_charge_percentage": 80.0000, "estimated_amount": 860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 860.8, "standard_charge_percentage": 80.0000, "estimated_amount": 860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 860.8, "standard_charge_percentage": 80.0000, "estimated_amount": 860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 429.32, "standard_charge_percentage": 42.0000, "estimated_amount": 429, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 256.72, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 860.8, "standard_charge_percentage": 80.0000, "estimated_amount": 860, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 968.4, "standard_charge_percentage": 90.0000, "estimated_amount": 968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 451.92, "standard_charge_percentage": 42.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 860.8, "standard_charge_percentage": 80.0000, "estimated_amount": 860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1076, "estimated_amount": 1076, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 914.6, "standard_charge_percentage": 85.0000, "estimated_amount": 914, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 860.8, "standard_charge_percentage": 80.0000, "estimated_amount": 860, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 860.8, "standard_charge_percentage": 80.0000, "estimated_amount": 860, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 968.4, "standard_charge_percentage": 90.0000, "estimated_amount": 968, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 438.36, "standard_charge_percentage": 42.0000, "estimated_amount": 438, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 860.8, "standard_charge_percentage": 80.0000, "estimated_amount": 860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 807, "standard_charge_percentage": 75.0000, "estimated_amount": 807, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 451.92, "standard_charge_percentage": 42.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 860.8, "standard_charge_percentage": 80.0000, "estimated_amount": 860, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1022.2, "standard_charge_percentage": 95.0000, "estimated_amount": 1022, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 538, "standard_charge_percentage": 50.0000, "estimated_amount": 538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 645.6, "standard_charge_percentage": 60.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 753.2, "standard_charge_percentage": 70.0000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 438.36, "standard_charge_percentage": 42.0000, "estimated_amount": 438, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 438.36, "standard_charge_percentage": 42.0000, "estimated_amount": 438, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 968.4, "standard_charge_percentage": 90.0000, "estimated_amount": 968, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 860.8, "standard_charge_percentage": 80.0000, "estimated_amount": 860, "methodology": "percent of total billed charges" }]}]} , { "description": "RPLC TUNNELED CV CATH W/PORT", "code_information": [ { "code": "11046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1235,"minimum": 256.72,"maximum": 1235,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 492.77, "standard_charge_percentage": 42.0000, "estimated_amount": 492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 988, "standard_charge_percentage": 80.0000, "estimated_amount": 988, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1080.63, "standard_charge_percentage": 87.5000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1235, "estimated_amount": 1235, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 503.14, "standard_charge_percentage": 42.0000, "estimated_amount": 503, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 864.5, "standard_charge_percentage": 70.0000, "estimated_amount": 864, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 617.5, "standard_charge_percentage": 50.0000, "estimated_amount": 617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 864.5, "standard_charge_percentage": 70.0000, "estimated_amount": 864, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 988, "standard_charge_percentage": 80.0000, "estimated_amount": 988, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 503.14, "standard_charge_percentage": 42.0000, "estimated_amount": 503, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1111.5, "standard_charge_percentage": 90.0000, "estimated_amount": 1111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 864.5, "standard_charge_percentage": 70.0000, "estimated_amount": 864, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1111.5, "standard_charge_percentage": 90.0000, "estimated_amount": 1111, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 988, "standard_charge_percentage": 80.0000, "estimated_amount": 988, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 741, "standard_charge_percentage": 60.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 518.7, "standard_charge_percentage": 42.0000, "estimated_amount": 518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 492.77, "standard_charge_percentage": 42.0000, "estimated_amount": 492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 256.72, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 518.7, "standard_charge_percentage": 42.0000, "estimated_amount": 518, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 988, "standard_charge_percentage": 80.0000, "estimated_amount": 988, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 988, "standard_charge_percentage": 80.0000, "estimated_amount": 988, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 926.25, "standard_charge_percentage": 75.0000, "estimated_amount": 926, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 988, "standard_charge_percentage": 80.0000, "estimated_amount": 988, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 503.14, "standard_charge_percentage": 42.0000, "estimated_amount": 503, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1049.75, "standard_charge_percentage": 85.0000, "estimated_amount": 1049, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 513.51, "standard_charge_percentage": 42.0000, "estimated_amount": 513, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 988, "standard_charge_percentage": 80.0000, "estimated_amount": 988, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1111.5, "standard_charge_percentage": 90.0000, "estimated_amount": 1111, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 503.14, "standard_charge_percentage": 42.0000, "estimated_amount": 503, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1235, "estimated_amount": 1235, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 988, "standard_charge_percentage": 80.0000, "estimated_amount": 988, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 370.5, "standard_charge_percentage": 30.0000, "estimated_amount": 370, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1173.25, "standard_charge_percentage": 95.0000, "estimated_amount": 1173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 256.72, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 988, "standard_charge_percentage": 80.0000, "estimated_amount": 988, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 988, "standard_charge_percentage": 80.0000, "estimated_amount": 988, "methodology": "percent of total billed charges" }]}]} , { "description": "COMPLETE RPL PICC WO PORT RS&I", "code_information": [ { "code": "11047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2310,"minimum": 282,"maximum": 2310,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1848, "standard_charge_percentage": 80.0000, "estimated_amount": 1848, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 941.09, "standard_charge_percentage": 42.0000, "estimated_amount": 941, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1963.5, "standard_charge_percentage": 85.0000, "estimated_amount": 1963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1617, "standard_charge_percentage": 70.0000, "estimated_amount": 1617, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 960.5, "standard_charge_percentage": 42.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1386, "standard_charge_percentage": 60.0000, "estimated_amount": 1386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1732.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1732, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1848, "standard_charge_percentage": 80.0000, "estimated_amount": 1848, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2310, "estimated_amount": 2310, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 970.2, "standard_charge_percentage": 42.0000, "estimated_amount": 970, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1848, "standard_charge_percentage": 80.0000, "estimated_amount": 1848, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1617, "standard_charge_percentage": 70.0000, "estimated_amount": 1617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 798.14, "estimated_amount": 798, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1848, "standard_charge_percentage": 80.0000, "estimated_amount": 1848, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1848, "standard_charge_percentage": 80.0000, "estimated_amount": 1848, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 941.09, "standard_charge_percentage": 42.0000, "estimated_amount": 941, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 693, "standard_charge_percentage": 30.0000, "estimated_amount": 693, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1155, "standard_charge_percentage": 50.0000, "estimated_amount": 1155, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 941.09, "standard_charge_percentage": 42.0000, "estimated_amount": 941, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 941.09, "standard_charge_percentage": 42.0000, "estimated_amount": 941, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2021.25, "standard_charge_percentage": 87.5000, "estimated_amount": 2021, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1848, "standard_charge_percentage": 80.0000, "estimated_amount": 1848, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1848, "standard_charge_percentage": 80.0000, "estimated_amount": 1848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1848, "standard_charge_percentage": 80.0000, "estimated_amount": 1848, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2079, "standard_charge_percentage": 90.0000, "estimated_amount": 2079, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2079, "standard_charge_percentage": 90.0000, "estimated_amount": 2079, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 970.2, "standard_charge_percentage": 42.0000, "estimated_amount": 970, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2194.5, "standard_charge_percentage": 95.0000, "estimated_amount": 2194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1617, "standard_charge_percentage": 70.0000, "estimated_amount": 1617, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2079, "standard_charge_percentage": 90.0000, "estimated_amount": 2079, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 921.69, "standard_charge_percentage": 42.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 921.69, "standard_charge_percentage": 42.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 798.14, "estimated_amount": 798, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1848, "standard_charge_percentage": 80.0000, "estimated_amount": 1848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1848, "standard_charge_percentage": 80.0000, "estimated_amount": 1848, "methodology": "percent of total billed charges" }]}]} , { "description": "Paringcutg b9 hyprker les 1", "code_information": [ { "code": "11055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297, "discounted_cash": 281,"minimum": 59.05,"maximum": 297,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 207.9, "standard_charge_percentage": 70.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 178.2, "standard_charge_percentage": 60.0000, "estimated_amount": 178, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 237.6, "standard_charge_percentage": 80.0000, "estimated_amount": 237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 89.1, "standard_charge_percentage": 30.0000, "estimated_amount": 89, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 297, "estimated_amount": 297, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 207.9, "standard_charge_percentage": 70.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 267.3, "standard_charge_percentage": 90.0000, "estimated_amount": 267, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 222.75, "standard_charge_percentage": 75.0000, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 237.6, "standard_charge_percentage": 80.0000, "estimated_amount": 237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 59.05, "estimated_amount": 59, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 124.74, "standard_charge_percentage": 42.0000, "estimated_amount": 124, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 118.5, "standard_charge_percentage": 42.0000, "estimated_amount": 118, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 259.88, "standard_charge_percentage": 87.5000, "estimated_amount": 259, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 237.6, "standard_charge_percentage": 80.0000, "estimated_amount": 237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 237.6, "standard_charge_percentage": 80.0000, "estimated_amount": 237, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 237.6, "standard_charge_percentage": 80.0000, "estimated_amount": 237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 123.49, "standard_charge_percentage": 42.0000, "estimated_amount": 123, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 297, "estimated_amount": 297, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 252.45, "standard_charge_percentage": 85.0000, "estimated_amount": 252, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 121, "standard_charge_percentage": 42.0000, "estimated_amount": 121, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 237.6, "standard_charge_percentage": 80.0000, "estimated_amount": 237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 145.03, "standard_charge_percentage": 48.8300, "estimated_amount": 145, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 121, "standard_charge_percentage": 42.0000, "estimated_amount": 121, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 121, "standard_charge_percentage": 42.0000, "estimated_amount": 121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 237.6, "standard_charge_percentage": 80.0000, "estimated_amount": 237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 118.5, "standard_charge_percentage": 42.0000, "estimated_amount": 118, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 267.3, "standard_charge_percentage": 90.0000, "estimated_amount": 267, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 148.5, "standard_charge_percentage": 50.0000, "estimated_amount": 148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 131.89, "estimated_amount": 131, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 267.3, "standard_charge_percentage": 90.0000, "estimated_amount": 267, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 237.6, "standard_charge_percentage": 80.0000, "estimated_amount": 237, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 237.6, "standard_charge_percentage": 80.0000, "estimated_amount": 237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 282.15, "standard_charge_percentage": 95.0000, "estimated_amount": 282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 237.6, "standard_charge_percentage": 80.0000, "estimated_amount": 237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 297, "estimated_amount": 297, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 124.74, "standard_charge_percentage": 42.0000, "estimated_amount": 124, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 121, "standard_charge_percentage": 42.0000, "estimated_amount": 121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 207.9, "standard_charge_percentage": 70.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" }]}]} , { "description": "PLC TUBE NASOGAST FLUOR GUIDE", "code_information": [ { "code": "11056", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285, "discounted_cash": 281,"minimum": 59.05,"maximum": 285,"payers_information":[{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 199.5, "standard_charge_percentage": 70.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 171, "standard_charge_percentage": 60.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 59.05, "estimated_amount": 59, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 242.25, "standard_charge_percentage": 85.0000, "estimated_amount": 242, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 285, "estimated_amount": 285, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 256.5, "standard_charge_percentage": 90.0000, "estimated_amount": 256, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 285, "estimated_amount": 285, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 119.7, "standard_charge_percentage": 42.0000, "estimated_amount": 119, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 228, "standard_charge_percentage": 80.0000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 116.11, "standard_charge_percentage": 42.0000, "estimated_amount": 116, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 256.5, "standard_charge_percentage": 90.0000, "estimated_amount": 256, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 116.11, "standard_charge_percentage": 42.0000, "estimated_amount": 116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 228, "standard_charge_percentage": 80.0000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 228, "standard_charge_percentage": 80.0000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 228, "standard_charge_percentage": 80.0000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 213.75, "standard_charge_percentage": 75.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 228, "standard_charge_percentage": 80.0000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 199.5, "standard_charge_percentage": 70.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 249.38, "standard_charge_percentage": 87.5000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 256.5, "standard_charge_percentage": 90.0000, "estimated_amount": 256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 118.5, "standard_charge_percentage": 42.0000, "estimated_amount": 118, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 85.5, "standard_charge_percentage": 30.0000, "estimated_amount": 85, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 199.5, "standard_charge_percentage": 70.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 116.11, "standard_charge_percentage": 42.0000, "estimated_amount": 116, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 228, "standard_charge_percentage": 80.0000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 113.72, "standard_charge_percentage": 42.0000, "estimated_amount": 113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 228, "standard_charge_percentage": 80.0000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 228, "standard_charge_percentage": 80.0000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 131.89, "estimated_amount": 131, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 119.7, "standard_charge_percentage": 42.0000, "estimated_amount": 119, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 228, "standard_charge_percentage": 80.0000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 116.11, "standard_charge_percentage": 42.0000, "estimated_amount": 116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 113.72, "standard_charge_percentage": 42.0000, "estimated_amount": 113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 285, "estimated_amount": 285, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 142.5, "standard_charge_percentage": 50.0000, "estimated_amount": 142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 139.17, "standard_charge_percentage": 48.8300, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 228, "standard_charge_percentage": 80.0000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 270.75, "standard_charge_percentage": 95.0000, "estimated_amount": 270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" }]}]} , { "description": "PUNCH BX SKIN EA ADDL LESION", "code_information": [ { "code": "11057", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312, "discounted_cash": 281,"minimum": 77.81,"maximum": 312,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 127.11, "standard_charge_percentage": 42.0000, "estimated_amount": 127, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 249.6, "standard_charge_percentage": 80.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 249.6, "standard_charge_percentage": 80.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 131.04, "standard_charge_percentage": 42.0000, "estimated_amount": 131, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 280.8, "standard_charge_percentage": 90.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 124.49, "standard_charge_percentage": 42.0000, "estimated_amount": 124, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 312, "estimated_amount": 312, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 234, "standard_charge_percentage": 75.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 127.11, "standard_charge_percentage": 42.0000, "estimated_amount": 127, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 129.73, "standard_charge_percentage": 42.0000, "estimated_amount": 129, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 249.6, "standard_charge_percentage": 80.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 312, "estimated_amount": 312, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 131.04, "standard_charge_percentage": 42.0000, "estimated_amount": 131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 152.35, "standard_charge_percentage": 48.8300, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 249.6, "standard_charge_percentage": 80.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 249.6, "standard_charge_percentage": 80.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 249.6, "standard_charge_percentage": 80.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 249.6, "standard_charge_percentage": 80.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 296.4, "standard_charge_percentage": 95.0000, "estimated_amount": 296, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 156, "standard_charge_percentage": 50.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 93.6, "standard_charge_percentage": 30.0000, "estimated_amount": 93, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 124.49, "standard_charge_percentage": 42.0000, "estimated_amount": 124, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 187.2, "standard_charge_percentage": 60.0000, "estimated_amount": 187, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 280.8, "standard_charge_percentage": 90.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 218.4, "standard_charge_percentage": 70.0000, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 249.6, "standard_charge_percentage": 80.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 249.6, "standard_charge_percentage": 80.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 273, "standard_charge_percentage": 87.5000, "estimated_amount": 273, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 280.8, "standard_charge_percentage": 90.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 218.4, "standard_charge_percentage": 70.0000, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 312, "estimated_amount": 312, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 265.2, "standard_charge_percentage": 85.0000, "estimated_amount": 265, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 249.6, "standard_charge_percentage": 80.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 218.4, "standard_charge_percentage": 70.0000, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 127.11, "standard_charge_percentage": 42.0000, "estimated_amount": 127, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 127.11, "standard_charge_percentage": 42.0000, "estimated_amount": 127, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" }]}]} , { "description": "Hc Tangential Biopsy Skin Single Lesion", "code_information": [ { "code": "11102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.25, "discounted_cash": 281,"minimum": 132.59,"maximum": 882.25,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 882.25, "estimated_amount": 882, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 617.58, "standard_charge_percentage": 70.0000, "estimated_amount": 617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 232.03, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 794.02, "standard_charge_percentage": 90.0000, "estimated_amount": 794, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 441.13, "standard_charge_percentage": 50.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 359.43, "standard_charge_percentage": 42.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 617.58, "standard_charge_percentage": 70.0000, "estimated_amount": 617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 264.68, "standard_charge_percentage": 30.0000, "estimated_amount": 264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 529.35, "standard_charge_percentage": 60.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 430.8, "standard_charge_percentage": 48.8300, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 352.02, "standard_charge_percentage": 42.0000, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 352.02, "standard_charge_percentage": 42.0000, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 661.69, "standard_charge_percentage": 75.0000, "estimated_amount": 661, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 359.43, "standard_charge_percentage": 42.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 359.43, "standard_charge_percentage": 42.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 370.55, "standard_charge_percentage": 42.0000, "estimated_amount": 370, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 794.02, "standard_charge_percentage": 90.0000, "estimated_amount": 794, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 794.02, "standard_charge_percentage": 90.0000, "estimated_amount": 794, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 441.13, "standard_charge_percentage": 50.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 359.43, "standard_charge_percentage": 42.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 370.55, "standard_charge_percentage": 42.0000, "estimated_amount": 370, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 232.03, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 838.14, "standard_charge_percentage": 95.0000, "estimated_amount": 838, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 366.84, "standard_charge_percentage": 42.0000, "estimated_amount": 366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 882.25, "estimated_amount": 882, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 749.91, "standard_charge_percentage": 85.0000, "estimated_amount": 749, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 617.58, "standard_charge_percentage": 70.0000, "estimated_amount": 617, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 771.97, "standard_charge_percentage": 87.5000, "estimated_amount": 771, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Tangential Biopsy Skin Ea Sep/Additional Lesion", "code_information": [ { "code": "11103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500,"minimum": 150,"maximum": 500,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 500, "estimated_amount": 500, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 250, "standard_charge_percentage": 50.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 250, "standard_charge_percentage": 50.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 207.9, "standard_charge_percentage": 42.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 210, "standard_charge_percentage": 42.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 437.5, "standard_charge_percentage": 87.5000, "estimated_amount": 437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 199.5, "standard_charge_percentage": 42.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 210, "standard_charge_percentage": 42.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 199.5, "standard_charge_percentage": 42.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 475, "standard_charge_percentage": 95.0000, "estimated_amount": 475, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150, "standard_charge_percentage": 30.0000, "estimated_amount": 150, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 300, "standard_charge_percentage": 60.0000, "estimated_amount": 300, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 375, "standard_charge_percentage": 75.0000, "estimated_amount": 375, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 425, "standard_charge_percentage": 85.0000, "estimated_amount": 425, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 500, "estimated_amount": 500, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" }]}]} , { "description": "Punch bx skin single lesion", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.25, "discounted_cash": 566,"minimum": 132.59,"maximum": 882.25,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 359.43, "standard_charge_percentage": 42.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 617.58, "standard_charge_percentage": 70.0000, "estimated_amount": 617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 430.8, "standard_charge_percentage": 48.8300, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 794.02, "standard_charge_percentage": 90.0000, "estimated_amount": 794, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 232.03, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 370.55, "standard_charge_percentage": 42.0000, "estimated_amount": 370, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 771.97, "standard_charge_percentage": 87.5000, "estimated_amount": 771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 794.02, "standard_charge_percentage": 90.0000, "estimated_amount": 794, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 882.25, "estimated_amount": 882, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 352.02, "standard_charge_percentage": 42.0000, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 794.02, "standard_charge_percentage": 90.0000, "estimated_amount": 794, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 882.25, "estimated_amount": 882, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 359.43, "standard_charge_percentage": 42.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 617.58, "standard_charge_percentage": 70.0000, "estimated_amount": 617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 370.55, "standard_charge_percentage": 42.0000, "estimated_amount": 370, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 441.13, "standard_charge_percentage": 50.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 352.02, "standard_charge_percentage": 42.0000, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 232.03, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 359.43, "standard_charge_percentage": 42.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 661.69, "standard_charge_percentage": 75.0000, "estimated_amount": 661, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 264.68, "standard_charge_percentage": 30.0000, "estimated_amount": 264, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 705.8, "standard_charge_percentage": 80.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 529.35, "standard_charge_percentage": 60.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 441.13, "standard_charge_percentage": 50.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 838.14, "standard_charge_percentage": 95.0000, "estimated_amount": 838, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 617.58, "standard_charge_percentage": 70.0000, "estimated_amount": 617, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 359.43, "standard_charge_percentage": 42.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 749.91, "standard_charge_percentage": 85.0000, "estimated_amount": 749, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 366.84, "standard_charge_percentage": 42.0000, "estimated_amount": 366, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Punch Biopsy Skin Ea Sep/Additional Lesion", "code_information": [ { "code": "11105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500,"minimum": 150,"maximum": 500,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 500, "estimated_amount": 500, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 203.7, "standard_charge_percentage": 42.0000, "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 300, "standard_charge_percentage": 60.0000, "estimated_amount": 300, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 500, "estimated_amount": 500, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 210, "standard_charge_percentage": 42.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 350, "standard_charge_percentage": 70.0000, "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 375, "standard_charge_percentage": 75.0000, "estimated_amount": 375, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 425, "standard_charge_percentage": 85.0000, "estimated_amount": 425, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 207.9, "standard_charge_percentage": 42.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 199.5, "standard_charge_percentage": 42.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 475, "standard_charge_percentage": 95.0000, "estimated_amount": 475, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 210, "standard_charge_percentage": 42.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 199.5, "standard_charge_percentage": 42.0000, "estimated_amount": 199, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 150, "standard_charge_percentage": 30.0000, "estimated_amount": 150, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 450, "standard_charge_percentage": 90.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 437.5, "standard_charge_percentage": 87.5000, "estimated_amount": 437, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 400, "standard_charge_percentage": 80.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 250, "standard_charge_percentage": 50.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 250, "standard_charge_percentage": 50.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Incisional Biopsy Skin Single Lesion", "code_information": [ { "code": "11106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1570.4, "discounted_cash": 868,"minimum": 253.8,"maximum": 1570.4,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 639.78, "standard_charge_percentage": 42.0000, "estimated_amount": 639, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1256.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1256, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1256.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 626.59, "standard_charge_percentage": 42.0000, "estimated_amount": 626, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1099.28, "standard_charge_percentage": 70.0000, "estimated_amount": 1099, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1256.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 659.57, "standard_charge_percentage": 42.0000, "estimated_amount": 659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1256.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1256, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1413.36, "standard_charge_percentage": 90.0000, "estimated_amount": 1413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1256.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1256, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 785.2, "standard_charge_percentage": 50.0000, "estimated_amount": 785, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 471.12, "standard_charge_percentage": 30.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1256.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 942.24, "standard_charge_percentage": 60.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1334.84, "standard_charge_percentage": 85.0000, "estimated_amount": 1334, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1099.28, "standard_charge_percentage": 70.0000, "estimated_amount": 1099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1099.28, "standard_charge_percentage": 70.0000, "estimated_amount": 1099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 412.99, "estimated_amount": 412, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 785.2, "standard_charge_percentage": 50.0000, "estimated_amount": 785, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 659.57, "standard_charge_percentage": 42.0000, "estimated_amount": 659, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1256.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1177.8, "standard_charge_percentage": 75.0000, "estimated_amount": 1177, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 639.78, "standard_charge_percentage": 42.0000, "estimated_amount": 639, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1570.4, "estimated_amount": 1570, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1256.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1256, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 652.97, "standard_charge_percentage": 42.0000, "estimated_amount": 652, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 626.59, "standard_charge_percentage": 42.0000, "estimated_amount": 626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1413.36, "standard_charge_percentage": 90.0000, "estimated_amount": 1413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 766.83, "standard_charge_percentage": 48.8300, "estimated_amount": 766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 639.78, "standard_charge_percentage": 42.0000, "estimated_amount": 639, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 412.99, "estimated_amount": 412, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 639.78, "standard_charge_percentage": 42.0000, "estimated_amount": 639, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1256.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1256.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1491.88, "standard_charge_percentage": 95.0000, "estimated_amount": 1491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1413.36, "standard_charge_percentage": 90.0000, "estimated_amount": 1413, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1374.1, "standard_charge_percentage": 87.5000, "estimated_amount": 1374, "methodology": "percent of total billed charges" }]}]} , { "description": "EXC BEN LES TRNK ARM 1.1-2.0CM", "code_information": [ { "code": "11200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.15, "discounted_cash": 281,"minimum": 77.81,"maximum": 6234.38,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 235.07, "standard_charge_percentage": 42.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 353.49, "standard_charge_percentage": 60.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 176.75, "standard_charge_percentage": 30.0000, "estimated_amount": 176, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 247.44, "standard_charge_percentage": 42.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 247.44, "standard_charge_percentage": 42.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 441.86, "standard_charge_percentage": 75.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 559.69, "standard_charge_percentage": 95.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 294.57, "standard_charge_percentage": 50.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 287.68, "standard_charge_percentage": 48.8300, "estimated_amount": 287, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 515.51, "standard_charge_percentage": 87.5000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 244.97, "standard_charge_percentage": 42.0000, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 235.07, "standard_charge_percentage": 42.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 500.78, "standard_charge_percentage": 85.0000, "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3281.26, "discounted_cash": 997,"minimum": 256.43,"maximum": 3281.26,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2296.88, "standard_charge_percentage": 70.0000, "estimated_amount": 2296, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2953.13, "standard_charge_percentage": 90.0000, "estimated_amount": 2953, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2296.88, "standard_charge_percentage": 70.0000, "estimated_amount": 2296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1336.79, "standard_charge_percentage": 42.0000, "estimated_amount": 1336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1309.22, "standard_charge_percentage": 42.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2625.01, "standard_charge_percentage": 80.0000, "estimated_amount": 2625, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2871.1, "standard_charge_percentage": 87.5000, "estimated_amount": 2871, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2625.01, "standard_charge_percentage": 80.0000, "estimated_amount": 2625, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2625.01, "standard_charge_percentage": 80.0000, "estimated_amount": 2625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2625.01, "standard_charge_percentage": 80.0000, "estimated_amount": 2625, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2953.13, "standard_charge_percentage": 90.0000, "estimated_amount": 2953, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1336.79, "standard_charge_percentage": 42.0000, "estimated_amount": 1336, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2625.01, "standard_charge_percentage": 80.0000, "estimated_amount": 2625, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2789.07, "standard_charge_percentage": 85.0000, "estimated_amount": 2789, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1336.79, "standard_charge_percentage": 42.0000, "estimated_amount": 1336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1336.79, "standard_charge_percentage": 42.0000, "estimated_amount": 1336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1364.35, "standard_charge_percentage": 42.0000, "estimated_amount": 1364, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2625.01, "standard_charge_percentage": 80.0000, "estimated_amount": 2625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 984.38, "standard_charge_percentage": 30.0000, "estimated_amount": 984, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2296.88, "standard_charge_percentage": 70.0000, "estimated_amount": 2296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2625.01, "standard_charge_percentage": 80.0000, "estimated_amount": 2625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1378.13, "standard_charge_percentage": 42.0000, "estimated_amount": 1378, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1309.22, "standard_charge_percentage": 42.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2460.95, "standard_charge_percentage": 75.0000, "estimated_amount": 2460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1602.24, "standard_charge_percentage": 48.8300, "estimated_amount": 1602, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1640.63, "standard_charge_percentage": 50.0000, "estimated_amount": 1640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3117.2, "standard_charge_percentage": 95.0000, "estimated_amount": 3117, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3281.26, "estimated_amount": 3281, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1378.13, "standard_charge_percentage": 42.0000, "estimated_amount": 1378, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1968.76, "standard_charge_percentage": 60.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2625.01, "standard_charge_percentage": 80.0000, "estimated_amount": 2625, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2953.13, "standard_charge_percentage": 90.0000, "estimated_amount": 2953, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2625.01, "standard_charge_percentage": 80.0000, "estimated_amount": 2625, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2625.01, "standard_charge_percentage": 80.0000, "estimated_amount": 2625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "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": 6562.5, "discounted_cash": 566,"minimum": 256.43,"maximum": 6234.38,"payers_information":[{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc tr-ext b9+marg 1.1-2 cm", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 997,"minimum": 256.43,"maximum": 6234.38,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext b9+marg 2.1-3cm", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 997,"minimum": 519.96,"maximum": 6234.38,"payers_information":[{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc Tr-Ext B9+Marg 3.1-4 Cm", "code_information": [ { "code": "11404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2297,"minimum": 519.96,"maximum": 6234.38,"payers_information":[{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc tr-ext b9+marg >4.0 cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6800, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6683.25,"payers_information":[{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2856, "standard_charge_percentage": 42.0000, "estimated_amount": 2856, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5440, "standard_charge_percentage": 80.0000, "estimated_amount": 5440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5628, "standard_charge_percentage": 80.0000, "estimated_amount": 5628, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2866.06, "standard_charge_percentage": 42.0000, "estimated_amount": 2866, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2806.96, "standard_charge_percentage": 42.0000, "estimated_amount": 2806, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6120, "standard_charge_percentage": 90.0000, "estimated_amount": 6120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6460, "standard_charge_percentage": 95.0000, "estimated_amount": 6460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2713.2, "standard_charge_percentage": 42.0000, "estimated_amount": 2713, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5780, "standard_charge_percentage": 85.0000, "estimated_amount": 5780, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2954.7, "standard_charge_percentage": 42.0000, "estimated_amount": 2954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3435.19, "standard_charge_percentage": 48.8300, "estimated_amount": 3435, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2770.32, "standard_charge_percentage": 42.0000, "estimated_amount": 2770, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5628, "standard_charge_percentage": 80.0000, "estimated_amount": 5628, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6331.5, "standard_charge_percentage": 90.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5628, "standard_charge_percentage": 80.0000, "estimated_amount": 5628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2770.32, "standard_charge_percentage": 42.0000, "estimated_amount": 2770, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5440, "standard_charge_percentage": 80.0000, "estimated_amount": 5440, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6331.5, "standard_charge_percentage": 90.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2866.06, "standard_charge_percentage": 42.0000, "estimated_amount": 2866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4080, "standard_charge_percentage": 60.0000, "estimated_amount": 4080, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5950, "standard_charge_percentage": 87.5000, "estimated_amount": 5950, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5440, "standard_charge_percentage": 80.0000, "estimated_amount": 5440, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4924.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4924, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2770.32, "standard_charge_percentage": 42.0000, "estimated_amount": 2770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3517.5, "standard_charge_percentage": 50.0000, "estimated_amount": 3517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3400, "standard_charge_percentage": 50.0000, "estimated_amount": 3400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2713.2, "standard_charge_percentage": 42.0000, "estimated_amount": 2713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4760, "standard_charge_percentage": 70.0000, "estimated_amount": 4760, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4924.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4924, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4924.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4924, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2770.32, "standard_charge_percentage": 42.0000, "estimated_amount": 2770, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6120, "standard_charge_percentage": 90.0000, "estimated_amount": 6120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5628, "standard_charge_percentage": 80.0000, "estimated_amount": 5628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6331.5, "standard_charge_percentage": 90.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3320.44, "standard_charge_percentage": 48.8300, "estimated_amount": 3320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5440, "standard_charge_percentage": 80.0000, "estimated_amount": 5440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5440, "standard_charge_percentage": 80.0000, "estimated_amount": 5440, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2856, "standard_charge_percentage": 42.0000, "estimated_amount": 2856, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5628, "standard_charge_percentage": 80.0000, "estimated_amount": 5628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6155.63, "standard_charge_percentage": 87.5000, "estimated_amount": 6155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2827.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2827, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5628, "standard_charge_percentage": 80.0000, "estimated_amount": 5628, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5440, "standard_charge_percentage": 80.0000, "estimated_amount": 5440, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2925.15, "standard_charge_percentage": 42.0000, "estimated_amount": 2925, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2866.06, "standard_charge_percentage": 42.0000, "estimated_amount": 2866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5440, "standard_charge_percentage": 80.0000, "estimated_amount": 5440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4760, "standard_charge_percentage": 70.0000, "estimated_amount": 4760, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5440, "standard_charge_percentage": 80.0000, "estimated_amount": 5440, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5628, "standard_charge_percentage": 80.0000, "estimated_amount": 5628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4221, "standard_charge_percentage": 60.0000, "estimated_amount": 4221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2806.96, "standard_charge_percentage": 42.0000, "estimated_amount": 2806, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2954.7, "standard_charge_percentage": 42.0000, "estimated_amount": 2954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2110.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2110, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5979.75, "standard_charge_percentage": 85.0000, "estimated_amount": 5979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5628, "standard_charge_percentage": 80.0000, "estimated_amount": 5628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4760, "standard_charge_percentage": 70.0000, "estimated_amount": 4760, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6683.25, "standard_charge_percentage": 95.0000, "estimated_amount": 6683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5276.25, "standard_charge_percentage": 75.0000, "estimated_amount": 5276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2040, "standard_charge_percentage": 30.0000, "estimated_amount": 2040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6120, "standard_charge_percentage": 90.0000, "estimated_amount": 6120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5100, "standard_charge_percentage": 75.0000, "estimated_amount": 5100, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5440, "standard_charge_percentage": 80.0000, "estimated_amount": 5440, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5628, "standard_charge_percentage": 80.0000, "estimated_amount": 5628, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2866.06, "standard_charge_percentage": 42.0000, "estimated_amount": 2866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5628, "standard_charge_percentage": 80.0000, "estimated_amount": 5628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5440, "standard_charge_percentage": 80.0000, "estimated_amount": 5440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" }]}]} , { "description": "EXC MAL LES SCLP HND 1.1-2.0CM", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 6234.38,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "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": 6562.5, "discounted_cash": 997,"minimum": 519.96,"maximum": 6234.38,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" }]}]} , { "description": "EXC BEN LES H-F-N-SP 2.1-3.0CM", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 6234.38,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" }]}]} , { "description": "EXC LES ABD WALL SUBQ 3CM/>", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6234.38,"payers_information":[{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4709.9, "estimated_amount": 4709, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "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": 7071.4, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Exc Skin Benig >4 Cm Scalp/Neck/Hnd/Ft/Gent", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" }]}]} , { "description": "US GUIDED FNA BX 1ST LESION", "code_information": [ { "code": "11440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2403.2, "discounted_cash": 997,"minimum": 256.43,"maximum": 2403.2,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1802.4, "standard_charge_percentage": 75.0000, "estimated_amount": 1802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1173.48, "standard_charge_percentage": 48.8300, "estimated_amount": 1173, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2403.2, "estimated_amount": 2403, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 999.25, "standard_charge_percentage": 42.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1441.92, "standard_charge_percentage": 60.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2283.04, "standard_charge_percentage": 95.0000, "estimated_amount": 2283, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2042.72, "standard_charge_percentage": 85.0000, "estimated_amount": 2042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 720.96, "standard_charge_percentage": 30.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2102.8, "standard_charge_percentage": 87.5000, "estimated_amount": 2102, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1201.6, "standard_charge_percentage": 50.0000, "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" }]}]} , { "description": "US GUIDE FNA BX EA ADD LESION", "code_information": [ { "code": "11441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2403.2, "discounted_cash": 997,"minimum": 256.43,"maximum": 6234.38,"payers_information":[{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2042.72, "standard_charge_percentage": 85.0000, "estimated_amount": 2042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2102.8, "standard_charge_percentage": 87.5000, "estimated_amount": 2102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 720.96, "standard_charge_percentage": 30.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 999.25, "standard_charge_percentage": 42.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1173.48, "standard_charge_percentage": 48.8300, "estimated_amount": 1173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1802.4, "standard_charge_percentage": 75.0000, "estimated_amount": 1802, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1201.6, "standard_charge_percentage": 50.0000, "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2403.2, "estimated_amount": 2403, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1441.92, "standard_charge_percentage": 60.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2283.04, "standard_charge_percentage": 95.0000, "estimated_amount": 2283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc Face-Mm B9+Marg 1.1-2 Cm", "code_information": [ { "code": "11442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 997,"minimum": 519.96,"maximum": 6234.38,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" }]}]} , { "description": "FNA BX W/FLUOR GD ADDL LESION", "code_information": [ { "code": "11443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 4474.4,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" }]}]} , { "description": "CT GUIDE FNA BX 1ST LESION", "code_information": [ { "code": "11444", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 4474.4,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" }]}]} , { "description": "CT GUIDE FNA BX ADDL LESION", "code_information": [ { "code": "11446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" }]}]} , { "description": "Exc skn hdrdnt ax smplntrm", "code_information": [ { "code": "11450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7512.5, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 7136.88,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6385.63, "standard_charge_percentage": 85.0000, "estimated_amount": 6385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2253.75, "standard_charge_percentage": 30.0000, "estimated_amount": 2253, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3060.59, "standard_charge_percentage": 42.0000, "estimated_amount": 3060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2997.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2997, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3668.35, "standard_charge_percentage": 48.8300, "estimated_amount": 3668, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3060.59, "standard_charge_percentage": 42.0000, "estimated_amount": 3060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7136.88, "standard_charge_percentage": 95.0000, "estimated_amount": 7136, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3155.25, "standard_charge_percentage": 42.0000, "estimated_amount": 3155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6573.44, "standard_charge_percentage": 87.5000, "estimated_amount": 6573, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3123.7, "standard_charge_percentage": 42.0000, "estimated_amount": 3123, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6761.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6761, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3060.59, "standard_charge_percentage": 42.0000, "estimated_amount": 3060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5634.38, "standard_charge_percentage": 75.0000, "estimated_amount": 5634, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4507.5, "standard_charge_percentage": 60.0000, "estimated_amount": 4507, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6761.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6761, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5258.75, "standard_charge_percentage": 70.0000, "estimated_amount": 5258, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3155.25, "standard_charge_percentage": 42.0000, "estimated_amount": 3155, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6761.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6761, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5258.75, "standard_charge_percentage": 70.0000, "estimated_amount": 5258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3060.59, "standard_charge_percentage": 42.0000, "estimated_amount": 3060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5258.75, "standard_charge_percentage": 70.0000, "estimated_amount": 5258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2997.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2997, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3756.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3756, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc skn hdrdnt ing smplntrm", "code_information": [ { "code": "11462", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6234.38,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc skn hppu smplntrm", "code_information": [ { "code": "11470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6234.38,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" }]}]} , { "description": "Hc Exc Skin Malig <0.5 Cm Trnk/Arm/Leg", "code_information": [ { "code": "11600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 997,"minimum": 420.66,"maximum": 4474.4,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext mal+marg 0.6-1 cm", "code_information": [ { "code": "11601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2403.2, "discounted_cash": 997,"minimum": 256.43,"maximum": 2403.2,"payers_information":[{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 999.25, "standard_charge_percentage": 42.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1441.92, "standard_charge_percentage": 60.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 720.96, "standard_charge_percentage": 30.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1802.4, "standard_charge_percentage": 75.0000, "estimated_amount": 1802, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1173.48, "standard_charge_percentage": 48.8300, "estimated_amount": 1173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2102.8, "standard_charge_percentage": 87.5000, "estimated_amount": 2102, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2283.04, "standard_charge_percentage": 95.0000, "estimated_amount": 2283, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1201.6, "standard_charge_percentage": 50.0000, "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2403.2, "estimated_amount": 2403, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2042.72, "standard_charge_percentage": 85.0000, "estimated_amount": 2042, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Exc Skin Malig 1.1-2 Cm Trnk/Arm/Leg", "code_information": [ { "code": "11602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2403.2, "discounted_cash": 566,"minimum": 256.43,"maximum": 2403.2,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2283.04, "standard_charge_percentage": 95.0000, "estimated_amount": 2283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2403.2, "estimated_amount": 2403, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2042.72, "standard_charge_percentage": 85.0000, "estimated_amount": 2042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1441.92, "standard_charge_percentage": 60.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1173.48, "standard_charge_percentage": 48.8300, "estimated_amount": 1173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 720.96, "standard_charge_percentage": 30.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 999.25, "standard_charge_percentage": 42.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1201.6, "standard_charge_percentage": 50.0000, "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2102.8, "standard_charge_percentage": 87.5000, "estimated_amount": 2102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1802.4, "standard_charge_percentage": 75.0000, "estimated_amount": 1802, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Exc Skin Malig 2.1-3 Cm Trnk/Arm/Leg", "code_information": [ { "code": "11603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 997,"minimum": 519.96,"maximum": 4474.4,"payers_information":[{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Exc Skin Malig 3.1-4 Cm Trnk/Arm/Leg", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 997,"minimum": 596,"maximum": 4474.4,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Exc Skin Malig >4 Cm Trnk/Arm/Leg", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc h-f-nk-sp mal+marg 0.5<", "code_information": [ { "code": "11620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 4474.4,"payers_information":[{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" }]}]} , { "description": "Exc snhfg mal+mrg 0.6-1", "code_information": [ { "code": "11621", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 997,"minimum": 256.43,"maximum": 4474.4,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" }]}]} , { "description": "INJ CNT ARTHROGRAM KNEE CT/MRI", "code_information": [ { "code": "11622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 997,"minimum": 519.96,"maximum": 6234.38,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" }]}]} , { "description": "MRI GUIDE NDL PLMT RS&I", "code_information": [ { "code": "11623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 4474.4,"payers_information":[{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" }]}]} , { "description": "INS PICC W/IMG GUIDE RS&I>5YRS", "code_information": [ { "code": "11624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" }]}]} , { "description": "RENAL BIOPSY PERQ", "code_information": [ { "code": "11626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc feenl mal+mrg 0.5cm<", "code_information": [ { "code": "11640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 997,"minimum": 256.43,"maximum": 6234.38,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" }]}]} , { "description": "Hc Trim Nail(S)", "code_information": [ { "code": "11719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195, "discounted_cash": 84,"minimum": 38.9,"maximum": 195,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 156, "standard_charge_percentage": 80.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 175.5, "standard_charge_percentage": 90.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 156, "standard_charge_percentage": 80.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 156, "standard_charge_percentage": 80.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 38.9, "standard_charge_percentage": 21.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 165.75, "standard_charge_percentage": 85.0000, "estimated_amount": 165, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 175.5, "standard_charge_percentage": 90.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 58.5, "standard_charge_percentage": 30.0000, "estimated_amount": 58, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 195, "estimated_amount": 195, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 156, "standard_charge_percentage": 80.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 57.61, "estimated_amount": 57, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 156, "standard_charge_percentage": 80.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 40.95, "standard_charge_percentage": 21.0000, "estimated_amount": 40, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 90.72, "estimated_amount": 90, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 68.04, "estimated_amount": 68, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 38.9, "standard_charge_percentage": 21.0000, "estimated_amount": 38, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 39.72, "standard_charge_percentage": 21.0000, "estimated_amount": 39, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 146.25, "standard_charge_percentage": 75.0000, "estimated_amount": 146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 131.89, "estimated_amount": 131, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 156, "standard_charge_percentage": 80.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 175.5, "standard_charge_percentage": 90.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 59.05, "estimated_amount": 59, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 117, "standard_charge_percentage": 60.0000, "estimated_amount": 117, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 136.5, "standard_charge_percentage": 70.0000, "estimated_amount": 136, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 156, "standard_charge_percentage": 80.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 195, "estimated_amount": 195, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 136.5, "standard_charge_percentage": 70.0000, "estimated_amount": 136, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 66.1, "estimated_amount": 66, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 156, "standard_charge_percentage": 80.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 40.54, "standard_charge_percentage": 21.0000, "estimated_amount": 40, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 69.08, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 39.72, "standard_charge_percentage": 21.0000, "estimated_amount": 39, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 39.72, "standard_charge_percentage": 21.0000, "estimated_amount": 39, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 136.5, "standard_charge_percentage": 70.0000, "estimated_amount": 136, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 156, "standard_charge_percentage": 80.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 39.72, "standard_charge_percentage": 21.0000, "estimated_amount": 39, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 66.1, "estimated_amount": 66, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 170.63, "standard_charge_percentage": 87.5000, "estimated_amount": 170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 95.22, "standard_charge_percentage": 48.8300, "estimated_amount": 95, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 195, "estimated_amount": 195, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 185.25, "standard_charge_percentage": 95.0000, "estimated_amount": 185, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 40.95, "standard_charge_percentage": 21.0000, "estimated_amount": 40, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 97.5, "standard_charge_percentage": 50.0000, "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 156, "standard_charge_percentage": 80.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" }]}]} , { "description": "Debride nail 1-5", "code_information": [ { "code": "11720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267, "discounted_cash": 84,"minimum": 57.61,"maximum": 267,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 213.6, "standard_charge_percentage": 80.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 106.53, "standard_charge_percentage": 42.0000, "estimated_amount": 106, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 186.9, "standard_charge_percentage": 70.0000, "estimated_amount": 186, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 108.78, "standard_charge_percentage": 42.0000, "estimated_amount": 108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 130.38, "standard_charge_percentage": 48.8300, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 213.6, "standard_charge_percentage": 80.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 267, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 69.08, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 267, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 66.1, "estimated_amount": 66, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 213.6, "standard_charge_percentage": 80.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 108.78, "standard_charge_percentage": 42.0000, "estimated_amount": 108, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 240.3, "standard_charge_percentage": 90.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 213.6, "standard_charge_percentage": 80.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 213.6, "standard_charge_percentage": 80.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 133.5, "standard_charge_percentage": 50.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 160.2, "standard_charge_percentage": 60.0000, "estimated_amount": 160, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 213.6, "standard_charge_percentage": 80.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 233.63, "standard_charge_percentage": 87.5000, "estimated_amount": 233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 213.6, "standard_charge_percentage": 80.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 68.04, "estimated_amount": 68, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 108.78, "standard_charge_percentage": 42.0000, "estimated_amount": 108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 80.1, "standard_charge_percentage": 30.0000, "estimated_amount": 80, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 59.05, "estimated_amount": 59, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 186.9, "standard_charge_percentage": 70.0000, "estimated_amount": 186, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 131.89, "estimated_amount": 131, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 186.9, "standard_charge_percentage": 70.0000, "estimated_amount": 186, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 106.53, "standard_charge_percentage": 42.0000, "estimated_amount": 106, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 213.6, "standard_charge_percentage": 80.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 112.14, "standard_charge_percentage": 42.0000, "estimated_amount": 112, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 112.14, "standard_charge_percentage": 42.0000, "estimated_amount": 112, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 108.78, "standard_charge_percentage": 42.0000, "estimated_amount": 108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 66.1, "estimated_amount": 66, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 240.3, "standard_charge_percentage": 90.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 226.95, "standard_charge_percentage": 85.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 267, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 90.72, "estimated_amount": 90, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 240.3, "standard_charge_percentage": 90.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 213.6, "standard_charge_percentage": 80.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 57.61, "estimated_amount": 57, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 253.65, "standard_charge_percentage": 95.0000, "estimated_amount": 253, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 213.6, "standard_charge_percentage": 80.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 200.25, "standard_charge_percentage": 75.0000, "estimated_amount": 200, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 111.02, "standard_charge_percentage": 42.0000, "estimated_amount": 111, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Debridement Of Nails, 6 Or More", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283, "discounted_cash": 84,"minimum": 57.61,"maximum": 283,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 66.1, "estimated_amount": 66, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 169.8, "standard_charge_percentage": 60.0000, "estimated_amount": 169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 198.1, "standard_charge_percentage": 70.0000, "estimated_amount": 198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 84.9, "standard_charge_percentage": 30.0000, "estimated_amount": 84, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 254.7, "standard_charge_percentage": 90.0000, "estimated_amount": 254, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 69.08, "estimated_amount": 69, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 112.92, "standard_charge_percentage": 42.0000, "estimated_amount": 112, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 283, "estimated_amount": 283, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 198.1, "standard_charge_percentage": 70.0000, "estimated_amount": 198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 131.89, "estimated_amount": 131, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 115.29, "standard_charge_percentage": 42.0000, "estimated_amount": 115, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 254.7, "standard_charge_percentage": 90.0000, "estimated_amount": 254, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 138.19, "standard_charge_percentage": 48.8300, "estimated_amount": 138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 115.29, "standard_charge_percentage": 42.0000, "estimated_amount": 115, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 141.5, "standard_charge_percentage": 50.0000, "estimated_amount": 141, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 118.86, "standard_charge_percentage": 42.0000, "estimated_amount": 118, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 66.1, "estimated_amount": 66, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 112.92, "standard_charge_percentage": 42.0000, "estimated_amount": 112, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 115.29, "standard_charge_percentage": 42.0000, "estimated_amount": 115, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 59.05, "estimated_amount": 59, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 240.55, "standard_charge_percentage": 85.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 68.04, "estimated_amount": 68, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 90.72, "estimated_amount": 90, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 283, "estimated_amount": 283, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 254.7, "standard_charge_percentage": 90.0000, "estimated_amount": 254, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 57.61, "estimated_amount": 57, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 268.85, "standard_charge_percentage": 95.0000, "estimated_amount": 268, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 115.29, "standard_charge_percentage": 42.0000, "estimated_amount": 115, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 212.25, "standard_charge_percentage": 75.0000, "estimated_amount": 212, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 117.67, "standard_charge_percentage": 42.0000, "estimated_amount": 117, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 247.63, "standard_charge_percentage": 87.5000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 198.1, "standard_charge_percentage": 70.0000, "estimated_amount": 198, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 118.86, "standard_charge_percentage": 42.0000, "estimated_amount": 118, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 64.8, "estimated_amount": 64, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Of Nail Plate", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 889, "discounted_cash": 281,"minimum": 77.81,"maximum": 6234.38,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 711.2, "standard_charge_percentage": 80.0000, "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 755.65, "standard_charge_percentage": 85.0000, "estimated_amount": 755, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 711.2, "standard_charge_percentage": 80.0000, "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 889, "estimated_amount": 889, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 711.2, "standard_charge_percentage": 80.0000, "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 800.1, "standard_charge_percentage": 90.0000, "estimated_amount": 800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 889, "estimated_amount": 889, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 362.18, "standard_charge_percentage": 42.0000, "estimated_amount": 362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 362.18, "standard_charge_percentage": 42.0000, "estimated_amount": 362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 369.65, "standard_charge_percentage": 42.0000, "estimated_amount": 369, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 373.38, "standard_charge_percentage": 42.0000, "estimated_amount": 373, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 711.2, "standard_charge_percentage": 80.0000, "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 434.1, "standard_charge_percentage": 48.8300, "estimated_amount": 434, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 711.2, "standard_charge_percentage": 80.0000, "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 777.88, "standard_charge_percentage": 87.5000, "estimated_amount": 777, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 354.71, "standard_charge_percentage": 42.0000, "estimated_amount": 354, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 711.2, "standard_charge_percentage": 80.0000, "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 666.75, "standard_charge_percentage": 75.0000, "estimated_amount": 666, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 266.7, "standard_charge_percentage": 30.0000, "estimated_amount": 266, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 444.5, "standard_charge_percentage": 50.0000, "estimated_amount": 444, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 533.4, "standard_charge_percentage": 60.0000, "estimated_amount": 533, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 711.2, "standard_charge_percentage": 80.0000, "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 711.2, "standard_charge_percentage": 80.0000, "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 362.18, "standard_charge_percentage": 42.0000, "estimated_amount": 362, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 800.1, "standard_charge_percentage": 90.0000, "estimated_amount": 800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 354.71, "standard_charge_percentage": 42.0000, "estimated_amount": 354, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 711.2, "standard_charge_percentage": 80.0000, "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 622.3, "standard_charge_percentage": 70.0000, "estimated_amount": 622, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 844.55, "standard_charge_percentage": 95.0000, "estimated_amount": 844, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 622.3, "standard_charge_percentage": 70.0000, "estimated_amount": 622, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 711.2, "standard_charge_percentage": 80.0000, "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 622.3, "standard_charge_percentage": 70.0000, "estimated_amount": 622, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 373.38, "standard_charge_percentage": 42.0000, "estimated_amount": 373, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 800.1, "standard_charge_percentage": 90.0000, "estimated_amount": 800, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 362.18, "standard_charge_percentage": 42.0000, "estimated_amount": 362, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Of Nail Plate, Simple, Ea Ad", "code_information": [ { "code": "11732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 855,"minimum": 77.81,"maximum": 855,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 256.5, "standard_charge_percentage": 30.0000, "estimated_amount": 256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 684, "standard_charge_percentage": 80.0000, "estimated_amount": 684, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 684, "standard_charge_percentage": 80.0000, "estimated_amount": 684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 598.5, "standard_charge_percentage": 70.0000, "estimated_amount": 598, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 598.5, "standard_charge_percentage": 70.0000, "estimated_amount": 598, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 748.13, "standard_charge_percentage": 87.5000, "estimated_amount": 748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 348.33, "standard_charge_percentage": 42.0000, "estimated_amount": 348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 684, "standard_charge_percentage": 80.0000, "estimated_amount": 684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 341.14, "standard_charge_percentage": 42.0000, "estimated_amount": 341, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 684, "standard_charge_percentage": 80.0000, "estimated_amount": 684, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 726.75, "standard_charge_percentage": 85.0000, "estimated_amount": 726, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 427.5, "standard_charge_percentage": 50.0000, "estimated_amount": 427, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 684, "standard_charge_percentage": 80.0000, "estimated_amount": 684, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 348.33, "standard_charge_percentage": 42.0000, "estimated_amount": 348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 684, "standard_charge_percentage": 80.0000, "estimated_amount": 684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 513, "standard_charge_percentage": 60.0000, "estimated_amount": 513, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 348.33, "standard_charge_percentage": 42.0000, "estimated_amount": 348, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 769.5, "standard_charge_percentage": 90.0000, "estimated_amount": 769, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 812.25, "standard_charge_percentage": 95.0000, "estimated_amount": 812, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 769.5, "standard_charge_percentage": 90.0000, "estimated_amount": 769, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 769.5, "standard_charge_percentage": 90.0000, "estimated_amount": 769, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 359.1, "standard_charge_percentage": 42.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 348.33, "standard_charge_percentage": 42.0000, "estimated_amount": 348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 641.25, "standard_charge_percentage": 75.0000, "estimated_amount": 641, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 684, "standard_charge_percentage": 80.0000, "estimated_amount": 684, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 598.5, "standard_charge_percentage": 70.0000, "estimated_amount": 598, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 684, "standard_charge_percentage": 80.0000, "estimated_amount": 684, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 355.51, "standard_charge_percentage": 42.0000, "estimated_amount": 355, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 684, "standard_charge_percentage": 80.0000, "estimated_amount": 684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 341.14, "standard_charge_percentage": 42.0000, "estimated_amount": 341, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 855, "estimated_amount": 855, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 684, "standard_charge_percentage": 80.0000, "estimated_amount": 684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 855, "estimated_amount": 855, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 359.1, "standard_charge_percentage": 42.0000, "estimated_amount": 359, "methodology": "percent of total billed charges" }]}]} , { "description": "Drain blood from under nail", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368, "discounted_cash": 182,"minimum": 39.3,"maximum": 368,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 140.62, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 257.6, "standard_charge_percentage": 70.0000, "estimated_amount": 257, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 184, "standard_charge_percentage": 50.0000, "estimated_amount": 184, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 149.92, "standard_charge_percentage": 42.0000, "estimated_amount": 149, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 143.43, "estimated_amount": 143, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 143.43, "estimated_amount": 143, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 294.4, "standard_charge_percentage": 80.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 276, "standard_charge_percentage": 75.0000, "estimated_amount": 276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 140.62, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 110.4, "standard_charge_percentage": 30.0000, "estimated_amount": 110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 39.3, "estimated_amount": 39, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 179.69, "standard_charge_percentage": 48.8300, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 294.4, "standard_charge_percentage": 80.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 140.62, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 257.6, "standard_charge_percentage": 70.0000, "estimated_amount": 257, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 62.95, "estimated_amount": 62, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 149.92, "standard_charge_percentage": 42.0000, "estimated_amount": 149, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 149.92, "standard_charge_percentage": 42.0000, "estimated_amount": 149, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 196.87, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 349.6, "standard_charge_percentage": 95.0000, "estimated_amount": 349, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 140.62, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 153.01, "standard_charge_percentage": 42.0000, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 140.62, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 312.8, "standard_charge_percentage": 85.0000, "estimated_amount": 312, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 294.4, "standard_charge_percentage": 80.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 294.4, "standard_charge_percentage": 80.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 140.62, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 154.56, "standard_charge_percentage": 42.0000, "estimated_amount": 154, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 368, "estimated_amount": 368, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 146.83, "standard_charge_percentage": 42.0000, "estimated_amount": 146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 140.62, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 154.56, "standard_charge_percentage": 42.0000, "estimated_amount": 154, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 294.4, "standard_charge_percentage": 80.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 149.9, "estimated_amount": 149, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 220.8, "standard_charge_percentage": 60.0000, "estimated_amount": 220, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 331.2, "standard_charge_percentage": 90.0000, "estimated_amount": 331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 294.4, "standard_charge_percentage": 80.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 322, "standard_charge_percentage": 87.5000, "estimated_amount": 322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 294.4, "standard_charge_percentage": 80.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 140.62, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 146.83, "standard_charge_percentage": 42.0000, "estimated_amount": 146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 294.4, "standard_charge_percentage": 80.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 294.4, "standard_charge_percentage": 80.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 140.62, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 331.2, "standard_charge_percentage": 90.0000, "estimated_amount": 331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 257.6, "standard_charge_percentage": 70.0000, "estimated_amount": 257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 140.62, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 294.4, "standard_charge_percentage": 80.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 140.62, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 106.03, "estimated_amount": 106, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 125.01, "estimated_amount": 125, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 368, "estimated_amount": 368, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 147.65, "estimated_amount": 147, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 39.3, "estimated_amount": 39, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 149.92, "standard_charge_percentage": 42.0000, "estimated_amount": 149, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 331.2, "standard_charge_percentage": 90.0000, "estimated_amount": 331, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Removal Of Nail Bed", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1923, "discounted_cash": 566,"minimum": 256.43,"maximum": 7303.13,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 783.43, "standard_charge_percentage": 42.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 783.43, "standard_charge_percentage": 42.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3131.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3131, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 256.86, "estimated_amount": 256, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6918.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6918, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1730.7, "standard_charge_percentage": 90.0000, "estimated_amount": 1730, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1923, "estimated_amount": 1923, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3228.75, "standard_charge_percentage": 42.0000, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1538.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5381.25, "standard_charge_percentage": 70.0000, "estimated_amount": 5381, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3843.75, "standard_charge_percentage": 50.0000, "estimated_amount": 3843, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 799.58, "standard_charge_percentage": 42.0000, "estimated_amount": 799, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1538.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1538.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 432.65, "estimated_amount": 432, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3131.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1442.25, "standard_charge_percentage": 75.0000, "estimated_amount": 1442, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 432.65, "estimated_amount": 432, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 767.28, "standard_charge_percentage": 42.0000, "estimated_amount": 767, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1346.1, "standard_charge_percentage": 70.0000, "estimated_amount": 1346, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 807.66, "standard_charge_percentage": 42.0000, "estimated_amount": 807, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2306.25, "standard_charge_percentage": 30.0000, "estimated_amount": 2306, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1538.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 767.28, "standard_charge_percentage": 42.0000, "estimated_amount": 767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5381.25, "standard_charge_percentage": 70.0000, "estimated_amount": 5381, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1826.85, "standard_charge_percentage": 95.0000, "estimated_amount": 1826, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5765.63, "standard_charge_percentage": 75.0000, "estimated_amount": 5765, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3131.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 576.9, "standard_charge_percentage": 30.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1538.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3196.46, "standard_charge_percentage": 42.0000, "estimated_amount": 3196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1634.55, "standard_charge_percentage": 85.0000, "estimated_amount": 1634, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 961.5, "standard_charge_percentage": 50.0000, "estimated_amount": 961, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6918.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1538.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6918.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6726.56, "standard_charge_percentage": 87.5000, "estimated_amount": 6726, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7303.13, "standard_charge_percentage": 95.0000, "estimated_amount": 7303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1538.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4612.5, "standard_charge_percentage": 60.0000, "estimated_amount": 4612, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1538.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1538.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3131.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3131, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 783.43, "standard_charge_percentage": 42.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1730.7, "standard_charge_percentage": 90.0000, "estimated_amount": 1730, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 807.66, "standard_charge_percentage": 42.0000, "estimated_amount": 807, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1346.1, "standard_charge_percentage": 70.0000, "estimated_amount": 1346, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3067.31, "standard_charge_percentage": 42.0000, "estimated_amount": 3067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3228.75, "standard_charge_percentage": 42.0000, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 256.86, "estimated_amount": 256, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1538.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1730.7, "standard_charge_percentage": 90.0000, "estimated_amount": 1730, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3067.31, "standard_charge_percentage": 42.0000, "estimated_amount": 3067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 939, "standard_charge_percentage": 48.8300, "estimated_amount": 939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1682.63, "standard_charge_percentage": 87.5000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 783.43, "standard_charge_percentage": 42.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6534.38, "standard_charge_percentage": 85.0000, "estimated_amount": 6534, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1153.8, "standard_charge_percentage": 60.0000, "estimated_amount": 1153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3753.81, "standard_charge_percentage": 48.8300, "estimated_amount": 3753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1346.1, "standard_charge_percentage": 70.0000, "estimated_amount": 1346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5381.25, "standard_charge_percentage": 70.0000, "estimated_amount": 5381, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Biopsy, Nail Unit (Sep Proc)", "code_information": [ { "code": "11755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2403.2, "discounted_cash": 997,"minimum": 256.43,"maximum": 2403.2,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1441.92, "standard_charge_percentage": 60.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 720.96, "standard_charge_percentage": 30.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1802.4, "standard_charge_percentage": 75.0000, "estimated_amount": 1802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1201.6, "standard_charge_percentage": 50.0000, "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2042.72, "standard_charge_percentage": 85.0000, "estimated_amount": 2042, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2102.8, "standard_charge_percentage": 87.5000, "estimated_amount": 2102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2403.2, "estimated_amount": 2403, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1173.48, "standard_charge_percentage": 48.8300, "estimated_amount": 1173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 999.25, "standard_charge_percentage": 42.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2283.04, "standard_charge_percentage": 95.0000, "estimated_amount": 2283, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" }]}]} , { "description": "Hc Reconstruc Of Nail Bed", "code_information": [ { "code": "11760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2143.35, "discounted_cash": 868,"minimum": 112.04,"maximum": 2143.35,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2143.35, "estimated_amount": 2143, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 855.2, "standard_charge_percentage": 42.0000, "estimated_amount": 855, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1500.35, "standard_charge_percentage": 70.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1929.02, "standard_charge_percentage": 90.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 900.21, "standard_charge_percentage": 42.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1286.01, "standard_charge_percentage": 60.0000, "estimated_amount": 1286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1929.02, "standard_charge_percentage": 90.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1046.6, "standard_charge_percentage": 48.8300, "estimated_amount": 1046, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 900.21, "standard_charge_percentage": 42.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1071.67, "standard_charge_percentage": 50.0000, "estimated_amount": 1071, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 855.2, "standard_charge_percentage": 42.0000, "estimated_amount": 855, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1607.51, "standard_charge_percentage": 75.0000, "estimated_amount": 1607, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1821.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1821, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1929.02, "standard_charge_percentage": 90.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1500.35, "standard_charge_percentage": 70.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1875.43, "standard_charge_percentage": 87.5000, "estimated_amount": 1875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 643, "standard_charge_percentage": 30.0000, "estimated_amount": 643, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1500.35, "standard_charge_percentage": 70.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 891.2, "standard_charge_percentage": 42.0000, "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2036.18, "standard_charge_percentage": 95.0000, "estimated_amount": 2036, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" }]}]} , { "description": "Hc Reconstruc Of Nail Bed W Graft", "code_information": [ { "code": "11762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8113.7, "discounted_cash": 2594,"minimum": 1045.33,"maximum": 7708.02,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6490.96, "standard_charge_percentage": 80.0000, "estimated_amount": 6490, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3305.52, "standard_charge_percentage": 42.0000, "estimated_amount": 3305, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7302.33, "standard_charge_percentage": 90.0000, "estimated_amount": 7302, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6490.96, "standard_charge_percentage": 80.0000, "estimated_amount": 6490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3961.92, "standard_charge_percentage": 48.8300, "estimated_amount": 3961, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4056.85, "standard_charge_percentage": 50.0000, "estimated_amount": 4056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3305.52, "standard_charge_percentage": 42.0000, "estimated_amount": 3305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2127.32, "estimated_amount": 2127, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6490.96, "standard_charge_percentage": 80.0000, "estimated_amount": 6490, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7302.33, "standard_charge_percentage": 90.0000, "estimated_amount": 7302, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3373.68, "standard_charge_percentage": 42.0000, "estimated_amount": 3373, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5679.59, "standard_charge_percentage": 70.0000, "estimated_amount": 5679, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 6085.27, "standard_charge_percentage": 75.0000, "estimated_amount": 6085, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5679.59, "standard_charge_percentage": 70.0000, "estimated_amount": 5679, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2793.85, "estimated_amount": 2793, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2434.11, "standard_charge_percentage": 30.0000, "estimated_amount": 2434, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7302.33, "standard_charge_percentage": 90.0000, "estimated_amount": 7302, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3305.52, "standard_charge_percentage": 42.0000, "estimated_amount": 3305, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1587.93, "estimated_amount": 1587, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6490.96, "standard_charge_percentage": 80.0000, "estimated_amount": 6490, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 7099.49, "standard_charge_percentage": 87.5000, "estimated_amount": 7099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6490.96, "standard_charge_percentage": 80.0000, "estimated_amount": 6490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3237.37, "standard_charge_percentage": 42.0000, "estimated_amount": 3237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3407.75, "standard_charge_percentage": 42.0000, "estimated_amount": 3407, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6490.96, "standard_charge_percentage": 80.0000, "estimated_amount": 6490, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6896.65, "standard_charge_percentage": 85.0000, "estimated_amount": 6896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3237.37, "standard_charge_percentage": 42.0000, "estimated_amount": 3237, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6490.96, "standard_charge_percentage": 80.0000, "estimated_amount": 6490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5679.59, "standard_charge_percentage": 70.0000, "estimated_amount": 5679, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6490.96, "standard_charge_percentage": 80.0000, "estimated_amount": 6490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4868.22, "standard_charge_percentage": 60.0000, "estimated_amount": 4868, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3305.52, "standard_charge_percentage": 42.0000, "estimated_amount": 3305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1774.1, "estimated_amount": 1774, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2095.39, "estimated_amount": 2095, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6490.96, "standard_charge_percentage": 80.0000, "estimated_amount": 6490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3407.75, "standard_charge_percentage": 42.0000, "estimated_amount": 3407, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7708.02, "standard_charge_percentage": 95.0000, "estimated_amount": 7708, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1501.29, "estimated_amount": 1501, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2674.68, "estimated_amount": 2674, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6490.96, "standard_charge_percentage": 80.0000, "estimated_amount": 6490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1501.29, "estimated_amount": 1501, "methodology": "fee schedule" }]}]} , { "description": "Hc Excision Of Nail Fold (Wedge), Toe", "code_information": [ { "code": "11765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.15, "discounted_cash": 566,"minimum": 77.81,"maximum": 589.15,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 287.68, "standard_charge_percentage": 48.8300, "estimated_amount": 287, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 235.07, "standard_charge_percentage": 42.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 247.44, "standard_charge_percentage": 42.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 500.78, "standard_charge_percentage": 85.0000, "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 235.07, "standard_charge_percentage": 42.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 441.86, "standard_charge_percentage": 75.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 176.75, "standard_charge_percentage": 30.0000, "estimated_amount": 176, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 294.57, "standard_charge_percentage": 50.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 353.49, "standard_charge_percentage": 60.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 515.51, "standard_charge_percentage": 87.5000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 244.97, "standard_charge_percentage": 42.0000, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 247.44, "standard_charge_percentage": 42.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 559.69, "standard_charge_percentage": 95.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" }]}]} , { "description": "Remove Pilonidal Cyst Simple", "code_information": [ { "code": "11770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 4059,"minimum": 1216,"maximum": 6717.83,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" }]}]} , { "description": "Remove pilonidal cyst exten", "code_information": [ { "code": "11771", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10036.9, "discounted_cash": 4059,"minimum": 1216,"maximum": 9535.06,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 7025.83, "standard_charge_percentage": 70.0000, "estimated_amount": 7025, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4215.5, "standard_charge_percentage": 42.0000, "estimated_amount": 4215, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4089.03, "standard_charge_percentage": 42.0000, "estimated_amount": 4089, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6022.14, "standard_charge_percentage": 60.0000, "estimated_amount": 6022, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 8029.52, "standard_charge_percentage": 80.0000, "estimated_amount": 8029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3011.07, "standard_charge_percentage": 30.0000, "estimated_amount": 3011, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4089.03, "standard_charge_percentage": 42.0000, "estimated_amount": 4089, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4173.34, "standard_charge_percentage": 42.0000, "estimated_amount": 4173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8029.52, "standard_charge_percentage": 80.0000, "estimated_amount": 8029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 4004.72, "standard_charge_percentage": 42.0000, "estimated_amount": 4004, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4215.5, "standard_charge_percentage": 42.0000, "estimated_amount": 4215, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 8782.29, "standard_charge_percentage": 87.5000, "estimated_amount": 8782, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 8029.52, "standard_charge_percentage": 80.0000, "estimated_amount": 8029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 9033.21, "standard_charge_percentage": 90.0000, "estimated_amount": 9033, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 9535.06, "standard_charge_percentage": 95.0000, "estimated_amount": 9535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 8029.52, "standard_charge_percentage": 80.0000, "estimated_amount": 8029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 7527.68, "standard_charge_percentage": 75.0000, "estimated_amount": 7527, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 7025.83, "standard_charge_percentage": 70.0000, "estimated_amount": 7025, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4089.03, "standard_charge_percentage": 42.0000, "estimated_amount": 4089, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 8029.52, "standard_charge_percentage": 80.0000, "estimated_amount": 8029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4089.03, "standard_charge_percentage": 42.0000, "estimated_amount": 4089, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 8029.52, "standard_charge_percentage": 80.0000, "estimated_amount": 8029, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 8029.52, "standard_charge_percentage": 80.0000, "estimated_amount": 8029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 4901.02, "standard_charge_percentage": 48.8300, "estimated_amount": 4901, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 8029.52, "standard_charge_percentage": 80.0000, "estimated_amount": 8029, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 7025.83, "standard_charge_percentage": 70.0000, "estimated_amount": 7025, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 8531.36, "standard_charge_percentage": 85.0000, "estimated_amount": 8531, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8029.52, "standard_charge_percentage": 80.0000, "estimated_amount": 8029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 9033.21, "standard_charge_percentage": 90.0000, "estimated_amount": 9033, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 9033.21, "standard_charge_percentage": 90.0000, "estimated_amount": 9033, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5018.45, "standard_charge_percentage": 50.0000, "estimated_amount": 5018, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 4004.72, "standard_charge_percentage": 42.0000, "estimated_amount": 4004, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 8029.52, "standard_charge_percentage": 80.0000, "estimated_amount": 8029, "methodology": "percent of total billed charges" }]}]} , { "description": "Remove pilonidal cyst compl", "code_information": [ { "code": "11772", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11624, "discounted_cash": 4059,"minimum": 1216,"maximum": 11042.8,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7920.32, "standard_charge_percentage": 90.0000, "estimated_amount": 7920, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4735.62, "standard_charge_percentage": 42.0000, "estimated_amount": 4735, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 10461.6, "standard_charge_percentage": 90.0000, "estimated_amount": 10461, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9299.2, "standard_charge_percentage": 80.0000, "estimated_amount": 9299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2640.11, "standard_charge_percentage": 30.0000, "estimated_amount": 2640, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4735.62, "standard_charge_percentage": 42.0000, "estimated_amount": 4735, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3487.2, "standard_charge_percentage": 30.0000, "estimated_amount": 3487, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3696.15, "standard_charge_percentage": 42.0000, "estimated_amount": 3696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6160.25, "standard_charge_percentage": 70.0000, "estimated_amount": 6160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9299.2, "standard_charge_percentage": 80.0000, "estimated_amount": 9299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 8136.8, "standard_charge_percentage": 70.0000, "estimated_amount": 8136, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6974.4, "standard_charge_percentage": 60.0000, "estimated_amount": 6974, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4882.08, "standard_charge_percentage": 42.0000, "estimated_amount": 4882, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3511.34, "standard_charge_percentage": 42.0000, "estimated_amount": 3511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 10461.6, "standard_charge_percentage": 90.0000, "estimated_amount": 10461, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7920.32, "standard_charge_percentage": 90.0000, "estimated_amount": 7920, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3585.27, "standard_charge_percentage": 42.0000, "estimated_amount": 3585, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4882.08, "standard_charge_percentage": 42.0000, "estimated_amount": 4882, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 9299.2, "standard_charge_percentage": 80.0000, "estimated_amount": 9299, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3585.27, "standard_charge_percentage": 42.0000, "estimated_amount": 3585, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5812, "standard_charge_percentage": 50.0000, "estimated_amount": 5812, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4735.62, "standard_charge_percentage": 42.0000, "estimated_amount": 4735, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 10461.6, "standard_charge_percentage": 90.0000, "estimated_amount": 10461, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 6600.27, "standard_charge_percentage": 75.0000, "estimated_amount": 6600, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 7480.31, "standard_charge_percentage": 85.0000, "estimated_amount": 7480, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 8360.34, "standard_charge_percentage": 95.0000, "estimated_amount": 8360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 4637.98, "standard_charge_percentage": 42.0000, "estimated_amount": 4637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 9299.2, "standard_charge_percentage": 80.0000, "estimated_amount": 9299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 10171, "standard_charge_percentage": 87.5000, "estimated_amount": 10171, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3585.27, "standard_charge_percentage": 42.0000, "estimated_amount": 3585, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 9299.2, "standard_charge_percentage": 80.0000, "estimated_amount": 9299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4400.18, "standard_charge_percentage": 50.0000, "estimated_amount": 4400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4735.62, "standard_charge_percentage": 42.0000, "estimated_amount": 4735, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 7700.31, "standard_charge_percentage": 87.5000, "estimated_amount": 7700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 4297.22, "standard_charge_percentage": 48.8300, "estimated_amount": 4297, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6160.25, "standard_charge_percentage": 70.0000, "estimated_amount": 6160, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 11042.8, "standard_charge_percentage": 95.0000, "estimated_amount": 11042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 8718, "standard_charge_percentage": 75.0000, "estimated_amount": 8718, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 8136.8, "standard_charge_percentage": 70.0000, "estimated_amount": 8136, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3696.15, "standard_charge_percentage": 42.0000, "estimated_amount": 3696, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 9880.4, "standard_charge_percentage": 85.0000, "estimated_amount": 9880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 9299.2, "standard_charge_percentage": 80.0000, "estimated_amount": 9299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4833.26, "standard_charge_percentage": 42.0000, "estimated_amount": 4833, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 9299.2, "standard_charge_percentage": 80.0000, "estimated_amount": 9299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 9299.2, "standard_charge_percentage": 80.0000, "estimated_amount": 9299, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 9299.2, "standard_charge_percentage": 80.0000, "estimated_amount": 9299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 9299.2, "standard_charge_percentage": 80.0000, "estimated_amount": 9299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 4637.98, "standard_charge_percentage": 42.0000, "estimated_amount": 4637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3659.19, "standard_charge_percentage": 42.0000, "estimated_amount": 3659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6160.25, "standard_charge_percentage": 70.0000, "estimated_amount": 6160, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7920.32, "standard_charge_percentage": 90.0000, "estimated_amount": 7920, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3585.27, "standard_charge_percentage": 42.0000, "estimated_amount": 3585, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5280.22, "standard_charge_percentage": 60.0000, "estimated_amount": 5280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3511.34, "standard_charge_percentage": 42.0000, "estimated_amount": 3511, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 8136.8, "standard_charge_percentage": 70.0000, "estimated_amount": 8136, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5676, "standard_charge_percentage": 48.8300, "estimated_amount": 5676, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Injection Intralesional >7 Lesions", "code_information": [ { "code": "11901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 953.75, "discounted_cash": 281,"minimum": 59.05,"maximum": 953.75,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 763, "standard_charge_percentage": 80.0000, "estimated_amount": 763, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 906.06, "standard_charge_percentage": 95.0000, "estimated_amount": 906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 388.56, "standard_charge_percentage": 42.0000, "estimated_amount": 388, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 400.57, "standard_charge_percentage": 42.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 59.05, "estimated_amount": 59, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 953.75, "estimated_amount": 953, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 834.53, "standard_charge_percentage": 87.5000, "estimated_amount": 834, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 858.38, "standard_charge_percentage": 90.0000, "estimated_amount": 858, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 763, "standard_charge_percentage": 80.0000, "estimated_amount": 763, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 286.13, "standard_charge_percentage": 30.0000, "estimated_amount": 286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 715.31, "standard_charge_percentage": 75.0000, "estimated_amount": 715, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 858.38, "standard_charge_percentage": 90.0000, "estimated_amount": 858, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 131.89, "estimated_amount": 131, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 388.56, "standard_charge_percentage": 42.0000, "estimated_amount": 388, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 380.55, "standard_charge_percentage": 42.0000, "estimated_amount": 380, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 763, "standard_charge_percentage": 80.0000, "estimated_amount": 763, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 667.63, "standard_charge_percentage": 70.0000, "estimated_amount": 667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 400.57, "standard_charge_percentage": 42.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 810.69, "standard_charge_percentage": 85.0000, "estimated_amount": 810, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 763, "standard_charge_percentage": 80.0000, "estimated_amount": 763, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 388.56, "standard_charge_percentage": 42.0000, "estimated_amount": 388, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 858.38, "standard_charge_percentage": 90.0000, "estimated_amount": 858, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 388.56, "standard_charge_percentage": 42.0000, "estimated_amount": 388, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 763, "standard_charge_percentage": 80.0000, "estimated_amount": 763, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 763, "standard_charge_percentage": 80.0000, "estimated_amount": 763, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 396.57, "standard_charge_percentage": 42.0000, "estimated_amount": 396, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 763, "standard_charge_percentage": 80.0000, "estimated_amount": 763, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 667.63, "standard_charge_percentage": 70.0000, "estimated_amount": 667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 572.25, "standard_charge_percentage": 60.0000, "estimated_amount": 572, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 763, "standard_charge_percentage": 80.0000, "estimated_amount": 763, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 476.88, "standard_charge_percentage": 50.0000, "estimated_amount": 476, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 763, "standard_charge_percentage": 80.0000, "estimated_amount": 763, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 953.75, "estimated_amount": 953, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 763, "standard_charge_percentage": 80.0000, "estimated_amount": 763, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 667.63, "standard_charge_percentage": 70.0000, "estimated_amount": 667, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 380.55, "standard_charge_percentage": 42.0000, "estimated_amount": 380, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 465.72, "standard_charge_percentage": 48.8300, "estimated_amount": 465, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Removal Non-Biodegradable Drug Delivery Implant", "code_information": [ { "code": "11982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2012.7, "discounted_cash": 565,"minimum": 102.6,"maximum": 2012.7,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1610.16, "standard_charge_percentage": 80.0000, "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 803.07, "standard_charge_percentage": 42.0000, "estimated_amount": 803, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.33, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1610.16, "standard_charge_percentage": 80.0000, "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.33, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 609.46, "estimated_amount": 609, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.33, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.33, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1610.16, "standard_charge_percentage": 80.0000, "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 803.07, "standard_charge_percentage": 42.0000, "estimated_amount": 803, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.04, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 845.33, "standard_charge_percentage": 42.0000, "estimated_amount": 845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1610.16, "standard_charge_percentage": 80.0000, "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1408.89, "standard_charge_percentage": 70.0000, "estimated_amount": 1408, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1811.43, "standard_charge_percentage": 90.0000, "estimated_amount": 1811, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.06, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 819.97, "standard_charge_percentage": 42.0000, "estimated_amount": 819, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 172.82, "estimated_amount": 172, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.01, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.33, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1912.07, "standard_charge_percentage": 95.0000, "estimated_amount": 1912, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 819.97, "standard_charge_percentage": 42.0000, "estimated_amount": 819, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1006.35, "standard_charge_percentage": 50.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1811.43, "standard_charge_percentage": 90.0000, "estimated_amount": 1811, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 603.81, "standard_charge_percentage": 30.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.33, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1610.16, "standard_charge_percentage": 80.0000, "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 836.88, "standard_charge_percentage": 42.0000, "estimated_amount": 836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1610.16, "standard_charge_percentage": 80.0000, "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1509.53, "standard_charge_percentage": 75.0000, "estimated_amount": 1509, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 982.8, "standard_charge_percentage": 48.8300, "estimated_amount": 982, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1610.16, "standard_charge_percentage": 80.0000, "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1610.16, "standard_charge_percentage": 80.0000, "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.33, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 102.6, "estimated_amount": 102, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.33, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.33, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2012.7, "estimated_amount": 2012, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1610.16, "standard_charge_percentage": 80.0000, "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1811.43, "standard_charge_percentage": 90.0000, "estimated_amount": 1811, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 819.97, "standard_charge_percentage": 42.0000, "estimated_amount": 819, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.33, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1408.89, "standard_charge_percentage": 70.0000, "estimated_amount": 1408, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 819.97, "standard_charge_percentage": 42.0000, "estimated_amount": 819, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.33, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1761.11, "standard_charge_percentage": 87.5000, "estimated_amount": 1761, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 845.33, "standard_charge_percentage": 42.0000, "estimated_amount": 845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.1, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1710.8, "standard_charge_percentage": 85.0000, "estimated_amount": 1710, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1610.16, "standard_charge_percentage": 80.0000, "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1207.62, "standard_charge_percentage": 60.0000, "estimated_amount": 1207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.04, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1408.89, "standard_charge_percentage": 70.0000, "estimated_amount": 1408, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Smp Body/Scalp/Extr <2.5 Cm", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 505, "discounted_cash": 281,"minimum": 112.04,"maximum": 505,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 479.75, "standard_charge_percentage": 95.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 404, "standard_charge_percentage": 80.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 201.49, "standard_charge_percentage": 42.0000, "estimated_amount": 201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 404, "standard_charge_percentage": 80.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 212.1, "standard_charge_percentage": 42.0000, "estimated_amount": 212, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 209.98, "standard_charge_percentage": 42.0000, "estimated_amount": 209, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 151.5, "standard_charge_percentage": 30.0000, "estimated_amount": 151, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 454.5, "standard_charge_percentage": 90.0000, "estimated_amount": 454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 378.75, "standard_charge_percentage": 75.0000, "estimated_amount": 378, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 454.5, "standard_charge_percentage": 90.0000, "estimated_amount": 454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 505, "estimated_amount": 505, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 212.1, "standard_charge_percentage": 42.0000, "estimated_amount": 212, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 441.88, "standard_charge_percentage": 87.5000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 353.5, "standard_charge_percentage": 70.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 205.74, "standard_charge_percentage": 42.0000, "estimated_amount": 205, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 404, "standard_charge_percentage": 80.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 429.25, "standard_charge_percentage": 85.0000, "estimated_amount": 429, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 404, "standard_charge_percentage": 80.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 404, "standard_charge_percentage": 80.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 353.5, "standard_charge_percentage": 70.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 252.5, "standard_charge_percentage": 50.0000, "estimated_amount": 252, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 353.5, "standard_charge_percentage": 70.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 205.74, "standard_charge_percentage": 42.0000, "estimated_amount": 205, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 205.74, "standard_charge_percentage": 42.0000, "estimated_amount": 205, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 303, "standard_charge_percentage": 60.0000, "estimated_amount": 303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 404, "standard_charge_percentage": 80.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 201.49, "standard_charge_percentage": 42.0000, "estimated_amount": 201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 505, "estimated_amount": 505, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 404, "standard_charge_percentage": 80.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 404, "standard_charge_percentage": 80.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 404, "standard_charge_percentage": 80.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 246.59, "standard_charge_percentage": 48.8300, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 205.74, "standard_charge_percentage": 42.0000, "estimated_amount": 205, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 404, "standard_charge_percentage": 80.0000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 454.5, "standard_charge_percentage": 90.0000, "estimated_amount": 454, "methodology": "percent of total billed charges" }]}]} , { "description": "Rpr S/N/Ax/Gen/Trnk2.6-7.5Cm", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8800.36, "discounted_cash": 281,"minimum": 112.04,"maximum": 8360.34,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6160.25, "standard_charge_percentage": 70.0000, "estimated_amount": 6160, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 420, "standard_charge_percentage": 80.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 459.38, "standard_charge_percentage": 87.5000, "estimated_amount": 459, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 262.5, "standard_charge_percentage": 50.0000, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 367.5, "standard_charge_percentage": 70.0000, "estimated_amount": 367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 256.36, "standard_charge_percentage": 48.8300, "estimated_amount": 256, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 420, "standard_charge_percentage": 80.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6160.25, "standard_charge_percentage": 70.0000, "estimated_amount": 6160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 472.5, "standard_charge_percentage": 90.0000, "estimated_amount": 472, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 420, "standard_charge_percentage": 80.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 220.5, "standard_charge_percentage": 42.0000, "estimated_amount": 220, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 213.88, "standard_charge_percentage": 42.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3585.27, "standard_charge_percentage": 42.0000, "estimated_amount": 3585, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3585.27, "standard_charge_percentage": 42.0000, "estimated_amount": 3585, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 420, "standard_charge_percentage": 80.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 6600.27, "standard_charge_percentage": 75.0000, "estimated_amount": 6600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7920.32, "standard_charge_percentage": 90.0000, "estimated_amount": 7920, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3696.15, "standard_charge_percentage": 42.0000, "estimated_amount": 3696, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4400.18, "standard_charge_percentage": 50.0000, "estimated_amount": 4400, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 367.5, "standard_charge_percentage": 70.0000, "estimated_amount": 367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2640.11, "standard_charge_percentage": 30.0000, "estimated_amount": 2640, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 220.5, "standard_charge_percentage": 42.0000, "estimated_amount": 220, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6160.25, "standard_charge_percentage": 70.0000, "estimated_amount": 6160, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 498.75, "standard_charge_percentage": 95.0000, "estimated_amount": 498, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3511.34, "standard_charge_percentage": 42.0000, "estimated_amount": 3511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 7480.31, "standard_charge_percentage": 85.0000, "estimated_amount": 7480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 4297.22, "standard_charge_percentage": 48.8300, "estimated_amount": 4297, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 420, "standard_charge_percentage": 80.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7920.32, "standard_charge_percentage": 90.0000, "estimated_amount": 7920, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3585.27, "standard_charge_percentage": 42.0000, "estimated_amount": 3585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 420, "standard_charge_percentage": 80.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 446.25, "standard_charge_percentage": 85.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 472.5, "standard_charge_percentage": 90.0000, "estimated_amount": 472, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 209.47, "standard_charge_percentage": 42.0000, "estimated_amount": 209, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 525, "estimated_amount": 525, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 525, "estimated_amount": 525, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 420, "standard_charge_percentage": 80.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 157.5, "standard_charge_percentage": 30.0000, "estimated_amount": 157, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 420, "standard_charge_percentage": 80.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5280.22, "standard_charge_percentage": 60.0000, "estimated_amount": 5280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 209.47, "standard_charge_percentage": 42.0000, "estimated_amount": 209, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 8360.34, "standard_charge_percentage": 95.0000, "estimated_amount": 8360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 393.75, "standard_charge_percentage": 75.0000, "estimated_amount": 393, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 420, "standard_charge_percentage": 80.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 218.29, "standard_charge_percentage": 42.0000, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3585.27, "standard_charge_percentage": 42.0000, "estimated_amount": 3585, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 213.88, "standard_charge_percentage": 42.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 213.88, "standard_charge_percentage": 42.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3696.15, "standard_charge_percentage": 42.0000, "estimated_amount": 3696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 420, "standard_charge_percentage": 80.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7920.32, "standard_charge_percentage": 90.0000, "estimated_amount": 7920, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 213.88, "standard_charge_percentage": 42.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 472.5, "standard_charge_percentage": 90.0000, "estimated_amount": 472, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 315, "standard_charge_percentage": 60.0000, "estimated_amount": 315, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3659.19, "standard_charge_percentage": 42.0000, "estimated_amount": 3659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 367.5, "standard_charge_percentage": 70.0000, "estimated_amount": 367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 7040.29, "standard_charge_percentage": 80.0000, "estimated_amount": 7040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3511.34, "standard_charge_percentage": 42.0000, "estimated_amount": 3511, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 7700.31, "standard_charge_percentage": 87.5000, "estimated_amount": 7700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Body/Scalp/Extr 7.6-12.5 Cm", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 576, "discounted_cash": 281,"minimum": 123.34,"maximum": 576,"payers_information":[{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 241.92, "standard_charge_percentage": 42.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 460.8, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 241.92, "standard_charge_percentage": 42.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 460.8, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 576, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 460.8, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 229.82, "standard_charge_percentage": 42.0000, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 403.2, "standard_charge_percentage": 70.0000, "estimated_amount": 403, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 234.66, "standard_charge_percentage": 42.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 172.8, "standard_charge_percentage": 30.0000, "estimated_amount": 172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 460.8, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 460.8, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 229.82, "standard_charge_percentage": 42.0000, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 576, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 234.66, "standard_charge_percentage": 42.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 547.2, "standard_charge_percentage": 95.0000, "estimated_amount": 547, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 518.4, "standard_charge_percentage": 90.0000, "estimated_amount": 518, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 234.66, "standard_charge_percentage": 42.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 460.8, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 518.4, "standard_charge_percentage": 90.0000, "estimated_amount": 518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 288, "standard_charge_percentage": 50.0000, "estimated_amount": 288, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 345.6, "standard_charge_percentage": 60.0000, "estimated_amount": 345, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 239.5, "standard_charge_percentage": 42.0000, "estimated_amount": 239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 460.8, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 460.8, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 460.8, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 403.2, "standard_charge_percentage": 70.0000, "estimated_amount": 403, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 234.66, "standard_charge_percentage": 42.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 432, "standard_charge_percentage": 75.0000, "estimated_amount": 432, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 403.2, "standard_charge_percentage": 70.0000, "estimated_amount": 403, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 460.8, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 504, "standard_charge_percentage": 87.5000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 489.6, "standard_charge_percentage": 85.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 281.26, "standard_charge_percentage": 48.8300, "estimated_amount": 281, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 518.4, "standard_charge_percentage": 90.0000, "estimated_amount": 518, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Smp Body/Scalp/Extr 12.6-20 Cm", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 643, "discounted_cash": 566,"minimum": 123.34,"maximum": 643,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 514.4, "standard_charge_percentage": 80.0000, "estimated_amount": 514, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 562.63, "standard_charge_percentage": 87.5000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 610.85, "standard_charge_percentage": 95.0000, "estimated_amount": 610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 313.98, "standard_charge_percentage": 48.8300, "estimated_amount": 313, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 514.4, "standard_charge_percentage": 80.0000, "estimated_amount": 514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 261.96, "standard_charge_percentage": 42.0000, "estimated_amount": 261, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 643, "estimated_amount": 643, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 256.56, "standard_charge_percentage": 42.0000, "estimated_amount": 256, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 578.7, "standard_charge_percentage": 90.0000, "estimated_amount": 578, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 450.1, "standard_charge_percentage": 70.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 482.25, "standard_charge_percentage": 75.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 192.9, "standard_charge_percentage": 30.0000, "estimated_amount": 192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 450.1, "standard_charge_percentage": 70.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 514.4, "standard_charge_percentage": 80.0000, "estimated_amount": 514, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 514.4, "standard_charge_percentage": 80.0000, "estimated_amount": 514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 578.7, "standard_charge_percentage": 90.0000, "estimated_amount": 578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 261.96, "standard_charge_percentage": 42.0000, "estimated_amount": 261, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 546.55, "standard_charge_percentage": 85.0000, "estimated_amount": 546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 514.4, "standard_charge_percentage": 80.0000, "estimated_amount": 514, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 643, "estimated_amount": 643, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 578.7, "standard_charge_percentage": 90.0000, "estimated_amount": 578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 321.5, "standard_charge_percentage": 50.0000, "estimated_amount": 321, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 261.96, "standard_charge_percentage": 42.0000, "estimated_amount": 261, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 267.36, "standard_charge_percentage": 42.0000, "estimated_amount": 267, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 270.06, "standard_charge_percentage": 42.0000, "estimated_amount": 270, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 514.4, "standard_charge_percentage": 80.0000, "estimated_amount": 514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 256.56, "standard_charge_percentage": 42.0000, "estimated_amount": 256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 514.4, "standard_charge_percentage": 80.0000, "estimated_amount": 514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 261.96, "standard_charge_percentage": 42.0000, "estimated_amount": 261, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 514.4, "standard_charge_percentage": 80.0000, "estimated_amount": 514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 385.8, "standard_charge_percentage": 60.0000, "estimated_amount": 385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 514.4, "standard_charge_percentage": 80.0000, "estimated_amount": 514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 514.4, "standard_charge_percentage": 80.0000, "estimated_amount": 514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 450.1, "standard_charge_percentage": 70.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 643, "estimated_amount": 643, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 270.06, "standard_charge_percentage": 42.0000, "estimated_amount": 270, "methodology": "percent of total billed charges" }]}]} , { "description": "Rpr snagentrk20.1-30.0cm", "code_information": [ { "code": "12006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11765, "discounted_cash": 566,"minimum": 123.34,"maximum": 11176.8,"payers_information":[{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3529.5, "standard_charge_percentage": 30.0000, "estimated_amount": 3529, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4941.3, "standard_charge_percentage": 42.0000, "estimated_amount": 4941, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 10000.3, "standard_charge_percentage": 85.0000, "estimated_amount": 10000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 9412, "standard_charge_percentage": 80.0000, "estimated_amount": 9412, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 10588.5, "standard_charge_percentage": 90.0000, "estimated_amount": 10588, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4891.89, "standard_charge_percentage": 42.0000, "estimated_amount": 4891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9412, "standard_charge_percentage": 80.0000, "estimated_amount": 9412, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 8823.75, "standard_charge_percentage": 75.0000, "estimated_amount": 8823, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 10588.5, "standard_charge_percentage": 90.0000, "estimated_amount": 10588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7059, "standard_charge_percentage": 60.0000, "estimated_amount": 7059, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 4694.23, "standard_charge_percentage": 42.0000, "estimated_amount": 4694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5744.85, "standard_charge_percentage": 48.8300, "estimated_amount": 5744, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4793.06, "standard_charge_percentage": 42.0000, "estimated_amount": 4793, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 9412, "standard_charge_percentage": 80.0000, "estimated_amount": 9412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9412, "standard_charge_percentage": 80.0000, "estimated_amount": 9412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 8235.5, "standard_charge_percentage": 70.0000, "estimated_amount": 8235, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 9412, "standard_charge_percentage": 80.0000, "estimated_amount": 9412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 9412, "standard_charge_percentage": 80.0000, "estimated_amount": 9412, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4793.06, "standard_charge_percentage": 42.0000, "estimated_amount": 4793, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 11176.8, "standard_charge_percentage": 95.0000, "estimated_amount": 11176, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 4694.23, "standard_charge_percentage": 42.0000, "estimated_amount": 4694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 8235.5, "standard_charge_percentage": 70.0000, "estimated_amount": 8235, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4793.06, "standard_charge_percentage": 42.0000, "estimated_amount": 4793, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4793.06, "standard_charge_percentage": 42.0000, "estimated_amount": 4793, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4941.3, "standard_charge_percentage": 42.0000, "estimated_amount": 4941, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 9412, "standard_charge_percentage": 80.0000, "estimated_amount": 9412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 9412, "standard_charge_percentage": 80.0000, "estimated_amount": 9412, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 10294.4, "standard_charge_percentage": 87.5000, "estimated_amount": 10294, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5882.5, "standard_charge_percentage": 50.0000, "estimated_amount": 5882, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 8235.5, "standard_charge_percentage": 70.0000, "estimated_amount": 8235, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 9412, "standard_charge_percentage": 80.0000, "estimated_amount": 9412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 9412, "standard_charge_percentage": 80.0000, "estimated_amount": 9412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 10588.5, "standard_charge_percentage": 90.0000, "estimated_amount": 10588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" }]}]} , { "description": "Rpr snaxgentrnk >30.0 cm", "code_information": [ { "code": "12007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 796, "discounted_cash": 281,"minimum": 123.34,"maximum": 796,"payers_information":[{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 796, "estimated_amount": 796, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 597, "standard_charge_percentage": 75.0000, "estimated_amount": 597, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 334.32, "standard_charge_percentage": 42.0000, "estimated_amount": 334, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 636.8, "standard_charge_percentage": 80.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 636.8, "standard_charge_percentage": 80.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 330.98, "standard_charge_percentage": 42.0000, "estimated_amount": 330, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 557.2, "standard_charge_percentage": 70.0000, "estimated_amount": 557, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 636.8, "standard_charge_percentage": 80.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 238.8, "standard_charge_percentage": 30.0000, "estimated_amount": 238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 696.5, "standard_charge_percentage": 87.5000, "estimated_amount": 696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 716.4, "standard_charge_percentage": 90.0000, "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 636.8, "standard_charge_percentage": 80.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 796, "estimated_amount": 796, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 716.4, "standard_charge_percentage": 90.0000, "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 676.6, "standard_charge_percentage": 85.0000, "estimated_amount": 676, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 636.8, "standard_charge_percentage": 80.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 796, "estimated_amount": 796, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 756.2, "standard_charge_percentage": 95.0000, "estimated_amount": 756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 388.69, "standard_charge_percentage": 48.8300, "estimated_amount": 388, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 557.2, "standard_charge_percentage": 70.0000, "estimated_amount": 557, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 796, "estimated_amount": 796, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 334.32, "standard_charge_percentage": 42.0000, "estimated_amount": 334, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 398, "standard_charge_percentage": 50.0000, "estimated_amount": 398, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 557.2, "standard_charge_percentage": 70.0000, "estimated_amount": 557, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 716.4, "standard_charge_percentage": 90.0000, "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 317.6, "standard_charge_percentage": 42.0000, "estimated_amount": 317, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 636.8, "standard_charge_percentage": 80.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 636.8, "standard_charge_percentage": 80.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 636.8, "standard_charge_percentage": 80.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 324.29, "standard_charge_percentage": 42.0000, "estimated_amount": 324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 636.8, "standard_charge_percentage": 80.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 324.29, "standard_charge_percentage": 42.0000, "estimated_amount": 324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 324.29, "standard_charge_percentage": 42.0000, "estimated_amount": 324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 317.6, "standard_charge_percentage": 42.0000, "estimated_amount": 317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 477.6, "standard_charge_percentage": 60.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 324.29, "standard_charge_percentage": 42.0000, "estimated_amount": 324, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 636.8, "standard_charge_percentage": 80.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" }]}]} , { "description": "Rpr feenlm 2.6-5.0 cm", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 551, "discounted_cash": 281,"minimum": 123.34,"maximum": 551,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 440.8, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 495.9, "standard_charge_percentage": 90.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 224.48, "standard_charge_percentage": 42.0000, "estimated_amount": 224, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 440.8, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 165.3, "standard_charge_percentage": 30.0000, "estimated_amount": 165, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 440.8, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 551, "estimated_amount": 551, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 523.45, "standard_charge_percentage": 95.0000, "estimated_amount": 523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 330.6, "standard_charge_percentage": 60.0000, "estimated_amount": 330, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 219.85, "standard_charge_percentage": 42.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 440.8, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 231.42, "standard_charge_percentage": 42.0000, "estimated_amount": 231, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 440.8, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 495.9, "standard_charge_percentage": 90.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 229.11, "standard_charge_percentage": 42.0000, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 219.85, "standard_charge_percentage": 42.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 495.9, "standard_charge_percentage": 90.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 275.5, "standard_charge_percentage": 50.0000, "estimated_amount": 275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 440.8, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 385.7, "standard_charge_percentage": 70.0000, "estimated_amount": 385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 440.8, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 551, "estimated_amount": 551, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 413.25, "standard_charge_percentage": 75.0000, "estimated_amount": 413, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 224.48, "standard_charge_percentage": 42.0000, "estimated_amount": 224, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 468.35, "standard_charge_percentage": 85.0000, "estimated_amount": 468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 385.7, "standard_charge_percentage": 70.0000, "estimated_amount": 385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 224.48, "standard_charge_percentage": 42.0000, "estimated_amount": 224, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 269.05, "standard_charge_percentage": 48.8300, "estimated_amount": 269, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 482.13, "standard_charge_percentage": 87.5000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 440.8, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 440.8, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 440.8, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 231.42, "standard_charge_percentage": 42.0000, "estimated_amount": 231, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 385.7, "standard_charge_percentage": 70.0000, "estimated_amount": 385, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 224.48, "standard_charge_percentage": 42.0000, "estimated_amount": 224, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 551, "estimated_amount": 551, "methodology": "case rate" }]}]} , { "description": "Hc Repr Wnd Smp Face 5.1-7.5 Cm", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 575, "discounted_cash": 281,"minimum": 123.34,"maximum": 575,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 229.42, "standard_charge_percentage": 42.0000, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 241.5, "standard_charge_percentage": 42.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 229.42, "standard_charge_percentage": 42.0000, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 575, "estimated_amount": 575, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 503.13, "standard_charge_percentage": 87.5000, "estimated_amount": 503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 517.5, "standard_charge_percentage": 90.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 460, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 234.25, "standard_charge_percentage": 42.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 546.25, "standard_charge_percentage": 95.0000, "estimated_amount": 546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 575, "estimated_amount": 575, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 575, "estimated_amount": 575, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 460, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 345, "standard_charge_percentage": 60.0000, "estimated_amount": 345, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 517.5, "standard_charge_percentage": 90.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 460, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 460, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 488.75, "standard_charge_percentage": 85.0000, "estimated_amount": 488, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 234.25, "standard_charge_percentage": 42.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 234.25, "standard_charge_percentage": 42.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 241.5, "standard_charge_percentage": 42.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 280.77, "standard_charge_percentage": 48.8300, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 460, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 460, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 460, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 239.09, "standard_charge_percentage": 42.0000, "estimated_amount": 239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 460, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 172.5, "standard_charge_percentage": 30.0000, "estimated_amount": 172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 460, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 402.5, "standard_charge_percentage": 70.0000, "estimated_amount": 402, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 517.5, "standard_charge_percentage": 90.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 431.25, "standard_charge_percentage": 75.0000, "estimated_amount": 431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 402.5, "standard_charge_percentage": 70.0000, "estimated_amount": 402, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 460, "standard_charge_percentage": 80.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 287.5, "standard_charge_percentage": 50.0000, "estimated_amount": 287, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 402.5, "standard_charge_percentage": 70.0000, "estimated_amount": 402, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 234.25, "standard_charge_percentage": 42.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Smp Face 7.6-12.5 Cm", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 627, "discounted_cash": 281,"minimum": 112.04,"maximum": 627,"payers_information":[{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 263.34, "standard_charge_percentage": 42.0000, "estimated_amount": 263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 255.44, "standard_charge_percentage": 42.0000, "estimated_amount": 255, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 627, "estimated_amount": 627, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 255.44, "standard_charge_percentage": 42.0000, "estimated_amount": 255, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 501, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 313.5, "standard_charge_percentage": 50.0000, "estimated_amount": 313, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 501, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 438.9, "standard_charge_percentage": 70.0000, "estimated_amount": 438, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 306.16, "standard_charge_percentage": 48.8300, "estimated_amount": 306, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 595.65, "standard_charge_percentage": 95.0000, "estimated_amount": 595, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 263.34, "standard_charge_percentage": 42.0000, "estimated_amount": 263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 250.17, "standard_charge_percentage": 42.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 438.9, "standard_charge_percentage": 70.0000, "estimated_amount": 438, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 627, "estimated_amount": 627, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 260.71, "standard_charge_percentage": 42.0000, "estimated_amount": 260, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 250.17, "standard_charge_percentage": 42.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 564.3, "standard_charge_percentage": 90.0000, "estimated_amount": 564, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 501, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 255.44, "standard_charge_percentage": 42.0000, "estimated_amount": 255, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 564.3, "standard_charge_percentage": 90.0000, "estimated_amount": 564, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 438.9, "standard_charge_percentage": 70.0000, "estimated_amount": 438, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 470.25, "standard_charge_percentage": 75.0000, "estimated_amount": 470, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 188.1, "standard_charge_percentage": 30.0000, "estimated_amount": 188, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 376.2, "standard_charge_percentage": 60.0000, "estimated_amount": 376, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 564.3, "standard_charge_percentage": 90.0000, "estimated_amount": 564, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 548.63, "standard_charge_percentage": 87.5000, "estimated_amount": 548, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 255.44, "standard_charge_percentage": 42.0000, "estimated_amount": 255, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 532.95, "standard_charge_percentage": 85.0000, "estimated_amount": 532, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 501, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Smp Face 12.6-20 Cm", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 721, "discounted_cash": 566,"minimum": 123.34,"maximum": 721,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 648.9, "standard_charge_percentage": 90.0000, "estimated_amount": 648, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 293.74, "standard_charge_percentage": 42.0000, "estimated_amount": 293, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 287.68, "standard_charge_percentage": 42.0000, "estimated_amount": 287, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 721, "estimated_amount": 721, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 648.9, "standard_charge_percentage": 90.0000, "estimated_amount": 648, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 432.6, "standard_charge_percentage": 60.0000, "estimated_amount": 432, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 684.95, "standard_charge_percentage": 95.0000, "estimated_amount": 684, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 504.7, "standard_charge_percentage": 70.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 302.82, "standard_charge_percentage": 42.0000, "estimated_amount": 302, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 630.88, "standard_charge_percentage": 87.5000, "estimated_amount": 630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 504.7, "standard_charge_percentage": 70.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 721, "estimated_amount": 721, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 540.75, "standard_charge_percentage": 75.0000, "estimated_amount": 540, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 721, "estimated_amount": 721, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 612.85, "standard_charge_percentage": 85.0000, "estimated_amount": 612, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 293.74, "standard_charge_percentage": 42.0000, "estimated_amount": 293, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 360.5, "standard_charge_percentage": 50.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 293.74, "standard_charge_percentage": 42.0000, "estimated_amount": 293, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 302.82, "standard_charge_percentage": 42.0000, "estimated_amount": 302, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 648.9, "standard_charge_percentage": 90.0000, "estimated_amount": 648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 216.3, "standard_charge_percentage": 30.0000, "estimated_amount": 216, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 721, "estimated_amount": 721, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 299.79, "standard_charge_percentage": 42.0000, "estimated_amount": 299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 287.68, "standard_charge_percentage": 42.0000, "estimated_amount": 287, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 352.06, "standard_charge_percentage": 48.8300, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 293.74, "standard_charge_percentage": 42.0000, "estimated_amount": 293, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 504.7, "standard_charge_percentage": 70.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Face 20.1-30 Cm", "code_information": [ { "code": "12017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1920, "discounted_cash": 566,"minimum": 123.34,"maximum": 1920,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1728, "standard_charge_percentage": 90.0000, "estimated_amount": 1728, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 782.21, "standard_charge_percentage": 42.0000, "estimated_amount": 782, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1344, "standard_charge_percentage": 70.0000, "estimated_amount": 1344, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1344, "standard_charge_percentage": 70.0000, "estimated_amount": 1344, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1920, "estimated_amount": 1920, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 798.34, "standard_charge_percentage": 42.0000, "estimated_amount": 798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 576, "standard_charge_percentage": 30.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1824, "standard_charge_percentage": 95.0000, "estimated_amount": 1824, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1344, "standard_charge_percentage": 70.0000, "estimated_amount": 1344, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 782.21, "standard_charge_percentage": 42.0000, "estimated_amount": 782, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1440, "standard_charge_percentage": 75.0000, "estimated_amount": 1440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 937.54, "standard_charge_percentage": 48.8300, "estimated_amount": 937, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 766.08, "standard_charge_percentage": 42.0000, "estimated_amount": 766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 1920, "estimated_amount": 1920, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1632, "standard_charge_percentage": 85.0000, "estimated_amount": 1632, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 782.21, "standard_charge_percentage": 42.0000, "estimated_amount": 782, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 806.4, "standard_charge_percentage": 42.0000, "estimated_amount": 806, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1152, "standard_charge_percentage": 60.0000, "estimated_amount": 1152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1728, "standard_charge_percentage": 90.0000, "estimated_amount": 1728, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 782.21, "standard_charge_percentage": 42.0000, "estimated_amount": 782, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 960, "standard_charge_percentage": 50.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1680, "standard_charge_percentage": 87.5000, "estimated_amount": 1680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1728, "standard_charge_percentage": 90.0000, "estimated_amount": 1728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 766.08, "standard_charge_percentage": 42.0000, "estimated_amount": 766, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 806.4, "standard_charge_percentage": 42.0000, "estimated_amount": 806, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Smp Face >30.1 Cm", "code_information": [ { "code": "12018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 662, "discounted_cash": 281,"minimum": 123.34,"maximum": 662,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 529.6, "standard_charge_percentage": 80.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 463.4, "standard_charge_percentage": 70.0000, "estimated_amount": 463, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 662, "estimated_amount": 662, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 331, "standard_charge_percentage": 50.0000, "estimated_amount": 331, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 595.8, "standard_charge_percentage": 90.0000, "estimated_amount": 595, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 529.6, "standard_charge_percentage": 80.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 529.6, "standard_charge_percentage": 80.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 463.4, "standard_charge_percentage": 70.0000, "estimated_amount": 463, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 628.9, "standard_charge_percentage": 95.0000, "estimated_amount": 628, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 662, "estimated_amount": 662, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 562.7, "standard_charge_percentage": 85.0000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 662, "estimated_amount": 662, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 662, "estimated_amount": 662, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 323.25, "standard_charge_percentage": 48.8300, "estimated_amount": 323, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 529.6, "standard_charge_percentage": 80.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 269.7, "standard_charge_percentage": 42.0000, "estimated_amount": 269, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 529.6, "standard_charge_percentage": 80.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 278.04, "standard_charge_percentage": 42.0000, "estimated_amount": 278, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 269.7, "standard_charge_percentage": 42.0000, "estimated_amount": 269, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 595.8, "standard_charge_percentage": 90.0000, "estimated_amount": 595, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 529.6, "standard_charge_percentage": 80.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 529.6, "standard_charge_percentage": 80.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 529.6, "standard_charge_percentage": 80.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 264.14, "standard_charge_percentage": 42.0000, "estimated_amount": 264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 579.25, "standard_charge_percentage": 87.5000, "estimated_amount": 579, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 529.6, "standard_charge_percentage": 80.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 397.2, "standard_charge_percentage": 60.0000, "estimated_amount": 397, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 463.4, "standard_charge_percentage": 70.0000, "estimated_amount": 463, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 278.04, "standard_charge_percentage": 42.0000, "estimated_amount": 278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 275.26, "standard_charge_percentage": 42.0000, "estimated_amount": 275, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 269.7, "standard_charge_percentage": 42.0000, "estimated_amount": 269, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 269.7, "standard_charge_percentage": 42.0000, "estimated_amount": 269, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 529.6, "standard_charge_percentage": 80.0000, "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 595.8, "standard_charge_percentage": 90.0000, "estimated_amount": 595, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 496.5, "standard_charge_percentage": 75.0000, "estimated_amount": 496, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 264.14, "standard_charge_percentage": 42.0000, "estimated_amount": 264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 198.6, "standard_charge_percentage": 30.0000, "estimated_amount": 198, "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": 2691, "discounted_cash": 868,"minimum": 256.43,"maximum": 2691,"payers_information":[{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1118.92, "standard_charge_percentage": 42.0000, "estimated_amount": 1118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1130.22, "standard_charge_percentage": 42.0000, "estimated_amount": 1130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2018.25, "standard_charge_percentage": 75.0000, "estimated_amount": 2018, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2152.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 807.3, "standard_charge_percentage": 30.0000, "estimated_amount": 807, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2421.9, "standard_charge_percentage": 90.0000, "estimated_amount": 2421, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2152.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1096.31, "standard_charge_percentage": 42.0000, "estimated_amount": 1096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2152.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2556.45, "standard_charge_percentage": 95.0000, "estimated_amount": 2556, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1883.7, "standard_charge_percentage": 70.0000, "estimated_amount": 1883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2152.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2152.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1096.31, "standard_charge_percentage": 42.0000, "estimated_amount": 1096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1345.5, "standard_charge_percentage": 50.0000, "estimated_amount": 1345, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1314.02, "standard_charge_percentage": 48.8300, "estimated_amount": 1314, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2421.9, "standard_charge_percentage": 90.0000, "estimated_amount": 2421, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2287.35, "standard_charge_percentage": 85.0000, "estimated_amount": 2287, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2152.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1130.22, "standard_charge_percentage": 42.0000, "estimated_amount": 1130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1073.71, "standard_charge_percentage": 42.0000, "estimated_amount": 1073, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1096.31, "standard_charge_percentage": 42.0000, "estimated_amount": 1096, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1096.31, "standard_charge_percentage": 42.0000, "estimated_amount": 1096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1883.7, "standard_charge_percentage": 70.0000, "estimated_amount": 1883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2152.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2421.9, "standard_charge_percentage": 90.0000, "estimated_amount": 2421, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2152.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2691, "estimated_amount": 2691, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1883.7, "standard_charge_percentage": 70.0000, "estimated_amount": 1883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1614.6, "standard_charge_percentage": 60.0000, "estimated_amount": 1614, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2354.63, "standard_charge_percentage": 87.5000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2152.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1073.71, "standard_charge_percentage": 42.0000, "estimated_amount": 1073, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2152.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2152, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr <2.5 Cm", "code_information": [ { "code": "12031", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 566,"minimum": 123.34,"maximum": 1201,"payers_information":[{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" }]}]} , { "description": "Intmd rpr satext 2.6-7.5", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 566,"minimum": 253.8,"maximum": 1201,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" }]}]} , { "description": "Intmd rpr strext 7.6-12.5", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 566,"minimum": 123.34,"maximum": 1201,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr 12.5-20 Cm", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2470, "discounted_cash": 566,"minimum": 123.34,"maximum": 2470,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1027.03, "standard_charge_percentage": 42.0000, "estimated_amount": 1027, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2099.5, "standard_charge_percentage": 85.0000, "estimated_amount": 2099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1852.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1235, "standard_charge_percentage": 50.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2161.25, "standard_charge_percentage": 87.5000, "estimated_amount": 2161, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1206.1, "standard_charge_percentage": 48.8300, "estimated_amount": 1206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1482, "standard_charge_percentage": 60.0000, "estimated_amount": 1482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2346.5, "standard_charge_percentage": 95.0000, "estimated_amount": 2346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2470, "estimated_amount": 2470, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 741, "standard_charge_percentage": 30.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" }]}]} , { "description": "Intmd rpr satext 20.1-30", "code_information": [ { "code": "12036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2470, "discounted_cash": 868,"minimum": 256.43,"maximum": 2470,"payers_information":[{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2470, "estimated_amount": 2470, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2346.5, "standard_charge_percentage": 95.0000, "estimated_amount": 2346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1206.1, "standard_charge_percentage": 48.8300, "estimated_amount": 1206, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 741, "standard_charge_percentage": 30.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1027.03, "standard_charge_percentage": 42.0000, "estimated_amount": 1027, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2161.25, "standard_charge_percentage": 87.5000, "estimated_amount": 2161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1852.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2099.5, "standard_charge_percentage": 85.0000, "estimated_amount": 2099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1482, "standard_charge_percentage": 60.0000, "estimated_amount": 1482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1235, "standard_charge_percentage": 50.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr >30.1 Cm", "code_information": [ { "code": "12037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2470, "discounted_cash": 2594,"minimum": 256.43,"maximum": 2470,"payers_information":[{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1774.1, "estimated_amount": 1774, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2161.25, "standard_charge_percentage": 87.5000, "estimated_amount": 2161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1027.03, "standard_charge_percentage": 42.0000, "estimated_amount": 1027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2127.32, "estimated_amount": 2127, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2470, "estimated_amount": 2470, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2470, "estimated_amount": 2470, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1206.1, "standard_charge_percentage": 48.8300, "estimated_amount": 1206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2095.39, "estimated_amount": 2095, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2470, "estimated_amount": 2470, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2346.5, "standard_charge_percentage": 95.0000, "estimated_amount": 2346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1235, "standard_charge_percentage": 50.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 741, "standard_charge_percentage": 30.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1852.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2099.5, "standard_charge_percentage": 85.0000, "estimated_amount": 2099, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1587.93, "estimated_amount": 1587, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1482, "standard_charge_percentage": 60.0000, "estimated_amount": 1482, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent <2.5 Cm", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 566,"minimum": 112.04,"maximum": 1201,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent 2.6-7.5 Cm", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2902, "discounted_cash": 566,"minimum": 123.34,"maximum": 2902,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1182.27, "standard_charge_percentage": 42.0000, "estimated_amount": 1182, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1182.27, "standard_charge_percentage": 42.0000, "estimated_amount": 1182, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2611.8, "standard_charge_percentage": 90.0000, "estimated_amount": 2611, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2611.8, "standard_charge_percentage": 90.0000, "estimated_amount": 2611, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1218.84, "standard_charge_percentage": 42.0000, "estimated_amount": 1218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1451, "standard_charge_percentage": 50.0000, "estimated_amount": 1451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1157.9, "standard_charge_percentage": 42.0000, "estimated_amount": 1157, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2902, "estimated_amount": 2902, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2031.4, "standard_charge_percentage": 70.0000, "estimated_amount": 2031, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2756.9, "standard_charge_percentage": 95.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1417.05, "standard_charge_percentage": 48.8300, "estimated_amount": 1417, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1741.2, "standard_charge_percentage": 60.0000, "estimated_amount": 1741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1206.65, "standard_charge_percentage": 42.0000, "estimated_amount": 1206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2539.25, "standard_charge_percentage": 87.5000, "estimated_amount": 2539, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2031.4, "standard_charge_percentage": 70.0000, "estimated_amount": 2031, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 870.6, "standard_charge_percentage": 30.0000, "estimated_amount": 870, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2611.8, "standard_charge_percentage": 90.0000, "estimated_amount": 2611, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2031.4, "standard_charge_percentage": 70.0000, "estimated_amount": 2031, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1218.84, "standard_charge_percentage": 42.0000, "estimated_amount": 1218, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1182.27, "standard_charge_percentage": 42.0000, "estimated_amount": 1182, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1157.9, "standard_charge_percentage": 42.0000, "estimated_amount": 1157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1182.27, "standard_charge_percentage": 42.0000, "estimated_amount": 1182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2466.7, "standard_charge_percentage": 85.0000, "estimated_amount": 2466, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2176.5, "standard_charge_percentage": 75.0000, "estimated_amount": 2176, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent 7.6-12.5 Cm", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3191, "discounted_cash": 868,"minimum": 123.34,"maximum": 3191,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1340.22, "standard_charge_percentage": 42.0000, "estimated_amount": 1340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2233.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1595.5, "standard_charge_percentage": 50.0000, "estimated_amount": 1595, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3031.45, "standard_charge_percentage": 95.0000, "estimated_amount": 3031, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1273.21, "standard_charge_percentage": 42.0000, "estimated_amount": 1273, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1326.82, "standard_charge_percentage": 42.0000, "estimated_amount": 1326, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2552.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2552, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1273.21, "standard_charge_percentage": 42.0000, "estimated_amount": 1273, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2552.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2552, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1300.01, "standard_charge_percentage": 42.0000, "estimated_amount": 1300, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2871.9, "standard_charge_percentage": 90.0000, "estimated_amount": 2871, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2792.13, "standard_charge_percentage": 87.5000, "estimated_amount": 2792, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 957.3, "standard_charge_percentage": 30.0000, "estimated_amount": 957, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1300.01, "standard_charge_percentage": 42.0000, "estimated_amount": 1300, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1340.22, "standard_charge_percentage": 42.0000, "estimated_amount": 1340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2552.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2552, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2552.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2552, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2712.35, "standard_charge_percentage": 85.0000, "estimated_amount": 2712, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2552.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2552, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2552.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2552, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1914.6, "standard_charge_percentage": 60.0000, "estimated_amount": 1914, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2552.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2552, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1300.01, "standard_charge_percentage": 42.0000, "estimated_amount": 1300, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2393.25, "standard_charge_percentage": 75.0000, "estimated_amount": 2393, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2552.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2552, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2871.9, "standard_charge_percentage": 90.0000, "estimated_amount": 2871, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3191, "estimated_amount": 3191, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2871.9, "standard_charge_percentage": 90.0000, "estimated_amount": 2871, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1300.01, "standard_charge_percentage": 42.0000, "estimated_amount": 1300, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2233.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2233, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2233.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2552.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2552, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1558.17, "standard_charge_percentage": 48.8300, "estimated_amount": 1558, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2552.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2552, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent 12.5-20 Cm", "code_information": [ { "code": "12045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 868,"minimum": 253.8,"maximum": 1201,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent 20.1-30 Cm", "code_information": [ { "code": "12046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 868,"minimum": 253.8,"maximum": 1201,"payers_information":[{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent >30.1 Cm", "code_information": [ { "code": "12047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 2594,"minimum": 256.43,"maximum": 1201,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" }]}]} , { "description": "Intmd rpr facemm 2.5 cm<", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 566,"minimum": 123.34,"maximum": 1201,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Intrmd Face 2.6-5.0 Cm", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 566,"minimum": 123.34,"maximum": 1201,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" }]}]} , { "description": "Intmd rpr facemm 5.1-7.5 cm", "code_information": [ { "code": "12053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 566,"minimum": 123.34,"maximum": 1201,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" }]}]} , { "description": "Intmd rpr facemm 7.6-12.5cm", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 566,"minimum": 112.04,"maximum": 1201,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 123.34, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" }]}]} , { "description": "Hc Repr Wnd Intrmd Face 12.6-20 Cm", "code_information": [ { "code": "12055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 566,"minimum": 253.8,"maximum": 1201,"payers_information":[{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Face 20.1-30 Cm", "code_information": [ { "code": "12056", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 566,"minimum": 132.59,"maximum": 1201,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Face >30.1 Cm", "code_information": [ { "code": "12057", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 566,"minimum": 253.8,"maximum": 1201,"payers_information":[{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Trunk 1.1-2.5 Cm", "code_information": [ { "code": "13100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2470, "discounted_cash": 868,"minimum": 256.43,"maximum": 2470,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1852.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2346.5, "standard_charge_percentage": 95.0000, "estimated_amount": 2346, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1206.1, "standard_charge_percentage": 48.8300, "estimated_amount": 1206, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1482, "standard_charge_percentage": 60.0000, "estimated_amount": 1482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2161.25, "standard_charge_percentage": 87.5000, "estimated_amount": 2161, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1587.93, "estimated_amount": 1587, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 741, "standard_charge_percentage": 30.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1027.03, "standard_charge_percentage": 42.0000, "estimated_amount": 1027, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2470, "estimated_amount": 2470, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2099.5, "standard_charge_percentage": 85.0000, "estimated_amount": 2099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1235, "standard_charge_percentage": 50.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2470, "estimated_amount": 2470, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Trnk 2.6-7.5 Cm", "code_information": [ { "code": "13101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2470, "discounted_cash": 868,"minimum": 256.43,"maximum": 2470,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2346.5, "standard_charge_percentage": 95.0000, "estimated_amount": 2346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1852.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2161.25, "standard_charge_percentage": 87.5000, "estimated_amount": 2161, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1482, "standard_charge_percentage": 60.0000, "estimated_amount": 1482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1027.03, "standard_charge_percentage": 42.0000, "estimated_amount": 1027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2099.5, "standard_charge_percentage": 85.0000, "estimated_amount": 2099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 741, "standard_charge_percentage": 30.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1206.1, "standard_charge_percentage": 48.8300, "estimated_amount": 1206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2470, "estimated_amount": 2470, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1235, "standard_charge_percentage": 50.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Cplx Trnk Add 5.0 Cm", "code_information": [ { "code": "13102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1146,"minimum": 282,"maximum": 1146,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 916.8, "standard_charge_percentage": 80.0000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 481.32, "standard_charge_percentage": 42.0000, "estimated_amount": 481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 916.8, "standard_charge_percentage": 80.0000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 916.8, "standard_charge_percentage": 80.0000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 476.51, "standard_charge_percentage": 42.0000, "estimated_amount": 476, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 457.25, "standard_charge_percentage": 42.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1002.75, "standard_charge_percentage": 87.5000, "estimated_amount": 1002, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 916.8, "standard_charge_percentage": 80.0000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 916.8, "standard_charge_percentage": 80.0000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 466.88, "standard_charge_percentage": 42.0000, "estimated_amount": 466, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 802.2, "standard_charge_percentage": 70.0000, "estimated_amount": 802, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 466.88, "standard_charge_percentage": 42.0000, "estimated_amount": 466, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 802.2, "standard_charge_percentage": 70.0000, "estimated_amount": 802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 916.8, "standard_charge_percentage": 80.0000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1031.4, "standard_charge_percentage": 90.0000, "estimated_amount": 1031, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1146, "estimated_amount": 1146, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 916.8, "standard_charge_percentage": 80.0000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 573, "standard_charge_percentage": 50.0000, "estimated_amount": 573, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 466.88, "standard_charge_percentage": 42.0000, "estimated_amount": 466, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 466.88, "standard_charge_percentage": 42.0000, "estimated_amount": 466, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 481.32, "standard_charge_percentage": 42.0000, "estimated_amount": 481, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 974.1, "standard_charge_percentage": 85.0000, "estimated_amount": 974, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 457.25, "standard_charge_percentage": 42.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1031.4, "standard_charge_percentage": 90.0000, "estimated_amount": 1031, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 859.5, "standard_charge_percentage": 75.0000, "estimated_amount": 859, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 802.2, "standard_charge_percentage": 70.0000, "estimated_amount": 802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 687.6, "standard_charge_percentage": 60.0000, "estimated_amount": 687, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1031.4, "standard_charge_percentage": 90.0000, "estimated_amount": 1031, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 343.8, "standard_charge_percentage": 30.0000, "estimated_amount": 343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 916.8, "standard_charge_percentage": 80.0000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1088.7, "standard_charge_percentage": 95.0000, "estimated_amount": 1088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 916.8, "standard_charge_percentage": 80.0000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 916.8, "standard_charge_percentage": 80.0000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Scalp 1.1-2.5 Cm", "code_information": [ { "code": "13120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 868,"minimum": 256.43,"maximum": 1201,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Scalp 2.6-7.5 Cm", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2470, "discounted_cash": 868,"minimum": 256.43,"maximum": 2470,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1852.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1482, "standard_charge_percentage": 60.0000, "estimated_amount": 1482, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2346.5, "standard_charge_percentage": 95.0000, "estimated_amount": 2346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 741, "standard_charge_percentage": 30.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1206.1, "standard_charge_percentage": 48.8300, "estimated_amount": 1206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1027.03, "standard_charge_percentage": 42.0000, "estimated_amount": 1027, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2470, "estimated_amount": 2470, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1235, "standard_charge_percentage": 50.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2099.5, "standard_charge_percentage": 85.0000, "estimated_amount": 2099, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2161.25, "standard_charge_percentage": 87.5000, "estimated_amount": 2161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Cplx Scalp Add 5.0 Cm", "code_information": [ { "code": "13122", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 767,"minimum": 230.1,"maximum": 767,"payers_information":[{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 536.9, "standard_charge_percentage": 70.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 312.48, "standard_charge_percentage": 42.0000, "estimated_amount": 312, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 383.5, "standard_charge_percentage": 50.0000, "estimated_amount": 383, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 613.6, "standard_charge_percentage": 80.0000, "estimated_amount": 613, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 575.25, "standard_charge_percentage": 75.0000, "estimated_amount": 575, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 671.13, "standard_charge_percentage": 87.5000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 613.6, "standard_charge_percentage": 80.0000, "estimated_amount": 613, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 460.2, "standard_charge_percentage": 60.0000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 322.14, "standard_charge_percentage": 42.0000, "estimated_amount": 322, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 690.3, "standard_charge_percentage": 90.0000, "estimated_amount": 690, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 312.48, "standard_charge_percentage": 42.0000, "estimated_amount": 312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 613.6, "standard_charge_percentage": 80.0000, "estimated_amount": 613, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 767, "estimated_amount": 767, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 651.95, "standard_charge_percentage": 85.0000, "estimated_amount": 651, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 690.3, "standard_charge_percentage": 90.0000, "estimated_amount": 690, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 613.6, "standard_charge_percentage": 80.0000, "estimated_amount": 613, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 322.14, "standard_charge_percentage": 42.0000, "estimated_amount": 322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 767, "estimated_amount": 767, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 306.03, "standard_charge_percentage": 42.0000, "estimated_amount": 306, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 613.6, "standard_charge_percentage": 80.0000, "estimated_amount": 613, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 613.6, "standard_charge_percentage": 80.0000, "estimated_amount": 613, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 536.9, "standard_charge_percentage": 70.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 613.6, "standard_charge_percentage": 80.0000, "estimated_amount": 613, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 613.6, "standard_charge_percentage": 80.0000, "estimated_amount": 613, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 613.6, "standard_charge_percentage": 80.0000, "estimated_amount": 613, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 312.48, "standard_charge_percentage": 42.0000, "estimated_amount": 312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 613.6, "standard_charge_percentage": 80.0000, "estimated_amount": 613, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 318.92, "standard_charge_percentage": 42.0000, "estimated_amount": 318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 306.03, "standard_charge_percentage": 42.0000, "estimated_amount": 306, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 728.65, "standard_charge_percentage": 95.0000, "estimated_amount": 728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 230.1, "standard_charge_percentage": 30.0000, "estimated_amount": 230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 536.9, "standard_charge_percentage": 70.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 690.3, "standard_charge_percentage": 90.0000, "estimated_amount": 690, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 312.48, "standard_charge_percentage": 42.0000, "estimated_amount": 312, "methodology": "percent of total billed charges" }]}]} , { "description": "Cmplx rpr fccmnaxghf", "code_information": [ { "code": "13131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 566,"minimum": 256.43,"maximum": 1201,"payers_information":[{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.42, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.2, "standard_charge_percentage": 42.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.38, "standard_charge_percentage": 42.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.29, "standard_charge_percentage": 42.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Cplx Face/Hnd/Ft/Gent 2.6-7.5 Cm", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2470, "discounted_cash": 868,"minimum": 256.43,"maximum": 2470,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1852.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2346.5, "standard_charge_percentage": 95.0000, "estimated_amount": 2346, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2099.5, "standard_charge_percentage": 85.0000, "estimated_amount": 2099, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2470, "estimated_amount": 2470, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1235, "standard_charge_percentage": 50.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1482, "standard_charge_percentage": 60.0000, "estimated_amount": 1482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 741, "standard_charge_percentage": 30.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1206.1, "standard_charge_percentage": 48.8300, "estimated_amount": 1206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2161.25, "standard_charge_percentage": 87.5000, "estimated_amount": 2161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1027.03, "standard_charge_percentage": 42.0000, "estimated_amount": 1027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Cplx Face/Hnd/Ft/Gent Ea Add 5.0 Cm", "code_information": [ { "code": "13133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 854,"minimum": 256.2,"maximum": 854,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 683.2, "standard_charge_percentage": 80.0000, "estimated_amount": 683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 597.8, "standard_charge_percentage": 70.0000, "estimated_amount": 597, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 597.8, "standard_charge_percentage": 70.0000, "estimated_amount": 597, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 347.92, "standard_charge_percentage": 42.0000, "estimated_amount": 347, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 347.92, "standard_charge_percentage": 42.0000, "estimated_amount": 347, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 811.3, "standard_charge_percentage": 95.0000, "estimated_amount": 811, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 683.2, "standard_charge_percentage": 80.0000, "estimated_amount": 683, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 854, "estimated_amount": 854, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 725.9, "standard_charge_percentage": 85.0000, "estimated_amount": 725, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 683.2, "standard_charge_percentage": 80.0000, "estimated_amount": 683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 256.2, "standard_charge_percentage": 30.0000, "estimated_amount": 256, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 768.6, "standard_charge_percentage": 90.0000, "estimated_amount": 768, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 347.92, "standard_charge_percentage": 42.0000, "estimated_amount": 347, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 347.92, "standard_charge_percentage": 42.0000, "estimated_amount": 347, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 683.2, "standard_charge_percentage": 80.0000, "estimated_amount": 683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 512.4, "standard_charge_percentage": 60.0000, "estimated_amount": 512, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 340.75, "standard_charge_percentage": 42.0000, "estimated_amount": 340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 683.2, "standard_charge_percentage": 80.0000, "estimated_amount": 683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 340.75, "standard_charge_percentage": 42.0000, "estimated_amount": 340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 640.5, "standard_charge_percentage": 75.0000, "estimated_amount": 640, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 427, "standard_charge_percentage": 50.0000, "estimated_amount": 427, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 768.6, "standard_charge_percentage": 90.0000, "estimated_amount": 768, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 854, "estimated_amount": 854, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 358.68, "standard_charge_percentage": 42.0000, "estimated_amount": 358, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 683.2, "standard_charge_percentage": 80.0000, "estimated_amount": 683, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 355.09, "standard_charge_percentage": 42.0000, "estimated_amount": 355, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 747.25, "standard_charge_percentage": 87.5000, "estimated_amount": 747, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 597.8, "standard_charge_percentage": 70.0000, "estimated_amount": 597, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 683.2, "standard_charge_percentage": 80.0000, "estimated_amount": 683, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 683.2, "standard_charge_percentage": 80.0000, "estimated_amount": 683, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 683.2, "standard_charge_percentage": 80.0000, "estimated_amount": 683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 358.68, "standard_charge_percentage": 42.0000, "estimated_amount": 358, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 683.2, "standard_charge_percentage": 80.0000, "estimated_amount": 683, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 768.6, "standard_charge_percentage": 90.0000, "estimated_amount": 768, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Cplx Eye/Ear/Nose/Lip 1.1-2.5 Cm", "code_information": [ { "code": "13151", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2470, "discounted_cash": 868,"minimum": 256.43,"maximum": 2470,"payers_information":[{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1027.03, "standard_charge_percentage": 42.0000, "estimated_amount": 1027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2099.5, "standard_charge_percentage": 85.0000, "estimated_amount": 2099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1482, "standard_charge_percentage": 60.0000, "estimated_amount": 1482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2470, "estimated_amount": 2470, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1235, "standard_charge_percentage": 50.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2346.5, "standard_charge_percentage": 95.0000, "estimated_amount": 2346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 741, "standard_charge_percentage": 30.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2161.25, "standard_charge_percentage": 87.5000, "estimated_amount": 2161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1852.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1206.1, "standard_charge_percentage": 48.8300, "estimated_amount": 1206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Cplx Eye/Ear/Nose/Lip 2.6-7.5 Cm", "code_information": [ { "code": "13152", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2470, "discounted_cash": 868,"minimum": 256.43,"maximum": 2470,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1852.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1482, "standard_charge_percentage": 60.0000, "estimated_amount": 1482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1206.1, "standard_charge_percentage": 48.8300, "estimated_amount": 1206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2161.25, "standard_charge_percentage": 87.5000, "estimated_amount": 2161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2470, "estimated_amount": 2470, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2346.5, "standard_charge_percentage": 95.0000, "estimated_amount": 2346, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1729, "standard_charge_percentage": 70.0000, "estimated_amount": 1729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1027.03, "standard_charge_percentage": 42.0000, "estimated_amount": 1027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1006.28, "standard_charge_percentage": 42.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 741, "standard_charge_percentage": 30.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1235, "standard_charge_percentage": 50.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1037.4, "standard_charge_percentage": 42.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2223, "standard_charge_percentage": 90.0000, "estimated_amount": 2223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 985.53, "standard_charge_percentage": 42.0000, "estimated_amount": 985, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2099.5, "standard_charge_percentage": 85.0000, "estimated_amount": 2099, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1976, "standard_charge_percentage": 80.0000, "estimated_amount": 1976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Cplx Eye/Ear/Nose/Lip Ea Add 5.0 Cm", "code_information": [ { "code": "13153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1011,"minimum": 282,"maximum": 1011,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 303.3, "standard_charge_percentage": 30.0000, "estimated_amount": 303, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 420.37, "standard_charge_percentage": 42.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 411.88, "standard_charge_percentage": 42.0000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 808.8, "standard_charge_percentage": 80.0000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 403.39, "standard_charge_percentage": 42.0000, "estimated_amount": 403, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 707.7, "standard_charge_percentage": 70.0000, "estimated_amount": 707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 808.8, "standard_charge_percentage": 80.0000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 859.35, "standard_charge_percentage": 85.0000, "estimated_amount": 859, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1011, "estimated_amount": 1011, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 758.25, "standard_charge_percentage": 75.0000, "estimated_amount": 758, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 411.88, "standard_charge_percentage": 42.0000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1011, "estimated_amount": 1011, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 808.8, "standard_charge_percentage": 80.0000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 424.62, "standard_charge_percentage": 42.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 424.62, "standard_charge_percentage": 42.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 505.5, "standard_charge_percentage": 50.0000, "estimated_amount": 505, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 909.9, "standard_charge_percentage": 90.0000, "estimated_amount": 909, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 707.7, "standard_charge_percentage": 70.0000, "estimated_amount": 707, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 808.8, "standard_charge_percentage": 80.0000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 606.6, "standard_charge_percentage": 60.0000, "estimated_amount": 606, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 808.8, "standard_charge_percentage": 80.0000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 808.8, "standard_charge_percentage": 80.0000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 909.9, "standard_charge_percentage": 90.0000, "estimated_amount": 909, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 707.7, "standard_charge_percentage": 70.0000, "estimated_amount": 707, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 884.63, "standard_charge_percentage": 87.5000, "estimated_amount": 884, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 808.8, "standard_charge_percentage": 80.0000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 960.45, "standard_charge_percentage": 95.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 411.88, "standard_charge_percentage": 42.0000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 403.39, "standard_charge_percentage": 42.0000, "estimated_amount": 403, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 808.8, "standard_charge_percentage": 80.0000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 909.9, "standard_charge_percentage": 90.0000, "estimated_amount": 909, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 323.42, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 808.8, "standard_charge_percentage": 80.0000, "estimated_amount": 808, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 411.88, "standard_charge_percentage": 42.0000, "estimated_amount": 411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 808.8, "standard_charge_percentage": 80.0000, "estimated_amount": 808, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Secondary Closure Surg Wound Dehiscense Complicated", "code_information": [ { "code": "13160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201, "discounted_cash": 2594,"minimum": 239.6,"maximum": 1201,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 252.21, "standard_charge_percentage": 21.0000, "estimated_amount": 252, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 239.6, "standard_charge_percentage": 21.0000, "estimated_amount": 239, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 249.69, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1050.88, "standard_charge_percentage": 87.5000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 900.75, "standard_charge_percentage": 75.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 360.3, "standard_charge_percentage": 30.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 244.64, "standard_charge_percentage": 21.0000, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 252.21, "standard_charge_percentage": 21.0000, "estimated_amount": 252, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 244.64, "standard_charge_percentage": 21.0000, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 244.64, "standard_charge_percentage": 21.0000, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 586.45, "standard_charge_percentage": 48.8300, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 239.6, "standard_charge_percentage": 21.0000, "estimated_amount": 239, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1020.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 720.6, "standard_charge_percentage": 60.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 600.5, "standard_charge_percentage": 50.0000, "estimated_amount": 600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 244.64, "standard_charge_percentage": 21.0000, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 840.7, "standard_charge_percentage": 70.0000, "estimated_amount": 840, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1140.95, "standard_charge_percentage": 95.0000, "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 960.8, "standard_charge_percentage": 80.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1201, "estimated_amount": 1201, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" }]}]} , { "description": "Tis trnfr s/a/l 10 sq cm/<", "code_information": [ { "code": "14020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7512.5, "discounted_cash": 2594,"minimum": 1150,"maximum": 7136.88,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3060.59, "standard_charge_percentage": 42.0000, "estimated_amount": 3060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4507.5, "standard_charge_percentage": 60.0000, "estimated_amount": 4507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2997.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2997, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6573.44, "standard_charge_percentage": 87.5000, "estimated_amount": 6573, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1587.93, "estimated_amount": 1587, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6761.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6761, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2997.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2997, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6761.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6761, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1774.1, "estimated_amount": 1774, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5634.38, "standard_charge_percentage": 75.0000, "estimated_amount": 5634, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6761.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6761, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3756.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3756, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2095.39, "estimated_amount": 2095, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7136.88, "standard_charge_percentage": 95.0000, "estimated_amount": 7136, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5258.75, "standard_charge_percentage": 70.0000, "estimated_amount": 5258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3155.25, "standard_charge_percentage": 42.0000, "estimated_amount": 3155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3155.25, "standard_charge_percentage": 42.0000, "estimated_amount": 3155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2127.32, "estimated_amount": 2127, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1501.29, "estimated_amount": 1501, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5258.75, "standard_charge_percentage": 70.0000, "estimated_amount": 5258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2253.75, "standard_charge_percentage": 30.0000, "estimated_amount": 2253, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3060.59, "standard_charge_percentage": 42.0000, "estimated_amount": 3060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5258.75, "standard_charge_percentage": 70.0000, "estimated_amount": 5258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3060.59, "standard_charge_percentage": 42.0000, "estimated_amount": 3060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2793.85, "estimated_amount": 2793, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3123.7, "standard_charge_percentage": 42.0000, "estimated_amount": 3123, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3060.59, "standard_charge_percentage": 42.0000, "estimated_amount": 3060, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6385.63, "standard_charge_percentage": 85.0000, "estimated_amount": 6385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3668.35, "standard_charge_percentage": 48.8300, "estimated_amount": 3668, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6010, "standard_charge_percentage": 80.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2674.68, "estimated_amount": 2674, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1501.29, "estimated_amount": 1501, "methodology": "fee schedule" }]}]} , { "description": "Hc Adjacent Tissue Trns/Reargmt F/C/C/M/N/A/G/H/F 10Sqcm/&Lt", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2594,"minimum": 939.63,"maximum": 4709.9,"payers_information":[{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2674.68, "estimated_amount": 2674, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 989.08, "standard_charge_percentage": 21.0000, "estimated_amount": 989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2793.85, "estimated_amount": 2793, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 979.19, "standard_charge_percentage": 21.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 959.41, "standard_charge_percentage": 21.0000, "estimated_amount": 959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1501.29, "estimated_amount": 1501, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1587.93, "estimated_amount": 1587, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2095.39, "estimated_amount": 2095, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 959.41, "standard_charge_percentage": 21.0000, "estimated_amount": 959, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 989.08, "standard_charge_percentage": 21.0000, "estimated_amount": 989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2127.32, "estimated_amount": 2127, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1774.1, "estimated_amount": 1774, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 959.41, "standard_charge_percentage": 21.0000, "estimated_amount": 959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1501.29, "estimated_amount": 1501, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 959.41, "standard_charge_percentage": 21.0000, "estimated_amount": 959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 939.63, "standard_charge_percentage": 21.0000, "estimated_amount": 939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4709.9, "estimated_amount": 4709, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 939.63, "standard_charge_percentage": 21.0000, "estimated_amount": 939, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Prep Wnd Trk/Ar/Lg 100 Sqcm Or 1% Peds", "code_information": [ { "code": "15002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7056.05, "discounted_cash": 2594,"minimum": 256.43,"maximum": 6703.25,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5997.64, "standard_charge_percentage": 85.0000, "estimated_amount": 5997, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4233.63, "standard_charge_percentage": 60.0000, "estimated_amount": 4233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2793.85, "estimated_amount": 2793, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2815.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2815, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1774.1, "estimated_amount": 1774, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2116.82, "standard_charge_percentage": 30.0000, "estimated_amount": 2116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2095.39, "estimated_amount": 2095, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6703.25, "standard_charge_percentage": 95.0000, "estimated_amount": 6703, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3445.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1587.93, "estimated_amount": 1587, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6174.04, "standard_charge_percentage": 87.5000, "estimated_amount": 6174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2963.54, "standard_charge_percentage": 42.0000, "estimated_amount": 2963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2127.32, "estimated_amount": 2127, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5292.04, "standard_charge_percentage": 75.0000, "estimated_amount": 5292, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2815.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3528.03, "standard_charge_percentage": 50.0000, "estimated_amount": 3528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2933.91, "standard_charge_percentage": 42.0000, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2674.68, "estimated_amount": 2674, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2963.54, "standard_charge_percentage": 42.0000, "estimated_amount": 2963, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Prep Wnd Trk/Ar/Lg Ea Add 100 Sqcm Or 1% Peds", "code_information": [ { "code": "15003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1771,"minimum": 282,"maximum": 1771,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1328.25, "standard_charge_percentage": 75.0000, "estimated_amount": 1328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1239.7, "standard_charge_percentage": 70.0000, "estimated_amount": 1239, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 885.5, "standard_charge_percentage": 50.0000, "estimated_amount": 885, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 743.82, "standard_charge_percentage": 42.0000, "estimated_amount": 743, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 721.51, "standard_charge_percentage": 42.0000, "estimated_amount": 721, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1549.63, "standard_charge_percentage": 87.5000, "estimated_amount": 1549, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 721.51, "standard_charge_percentage": 42.0000, "estimated_amount": 721, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 721.51, "standard_charge_percentage": 42.0000, "estimated_amount": 721, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 743.82, "standard_charge_percentage": 42.0000, "estimated_amount": 743, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 706.63, "standard_charge_percentage": 42.0000, "estimated_amount": 706, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1062.6, "standard_charge_percentage": 60.0000, "estimated_amount": 1062, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1593.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1239.7, "standard_charge_percentage": 70.0000, "estimated_amount": 1239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1239.7, "standard_charge_percentage": 70.0000, "estimated_amount": 1239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 531.3, "standard_charge_percentage": 30.0000, "estimated_amount": 531, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 736.38, "standard_charge_percentage": 42.0000, "estimated_amount": 736, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1593.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1593.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 706.63, "standard_charge_percentage": 42.0000, "estimated_amount": 706, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1682.45, "standard_charge_percentage": 95.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 721.51, "standard_charge_percentage": 42.0000, "estimated_amount": 721, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1505.35, "standard_charge_percentage": 85.0000, "estimated_amount": 1505, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" }]}]} , { "description": "Wound prep fnhfg", "code_information": [ { "code": "15004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2143.35, "discounted_cash": 868,"minimum": 256.43,"maximum": 2143.35,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1286.01, "standard_charge_percentage": 60.0000, "estimated_amount": 1286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1500.35, "standard_charge_percentage": 70.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1046.6, "standard_charge_percentage": 48.8300, "estimated_amount": 1046, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 855.2, "standard_charge_percentage": 42.0000, "estimated_amount": 855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2036.18, "standard_charge_percentage": 95.0000, "estimated_amount": 2036, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1821.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 643, "standard_charge_percentage": 30.0000, "estimated_amount": 643, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1500.35, "standard_charge_percentage": 70.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 855.2, "standard_charge_percentage": 42.0000, "estimated_amount": 855, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1875.43, "standard_charge_percentage": 87.5000, "estimated_amount": 1875, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 900.21, "standard_charge_percentage": 42.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 891.2, "standard_charge_percentage": 42.0000, "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1607.51, "standard_charge_percentage": 75.0000, "estimated_amount": 1607, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 900.21, "standard_charge_percentage": 42.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1929.02, "standard_charge_percentage": 90.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2143.35, "estimated_amount": 2143, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1929.02, "standard_charge_percentage": 90.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1929.02, "standard_charge_percentage": 90.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1071.67, "standard_charge_percentage": 50.0000, "estimated_amount": 1071, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1500.35, "standard_charge_percentage": 70.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" }]}]} , { "description": "Hc Prep Wnd Head/Hnd/Ft/Gent Ea Add 100 Sqcm", "code_information": [ { "code": "15005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1771,"minimum": 282,"maximum": 1771,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 721.51, "standard_charge_percentage": 42.0000, "estimated_amount": 721, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1682.45, "standard_charge_percentage": 95.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1239.7, "standard_charge_percentage": 70.0000, "estimated_amount": 1239, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 531.3, "standard_charge_percentage": 30.0000, "estimated_amount": 531, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 706.63, "standard_charge_percentage": 42.0000, "estimated_amount": 706, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 721.51, "standard_charge_percentage": 42.0000, "estimated_amount": 721, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1239.7, "standard_charge_percentage": 70.0000, "estimated_amount": 1239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1239.7, "standard_charge_percentage": 70.0000, "estimated_amount": 1239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1062.6, "standard_charge_percentage": 60.0000, "estimated_amount": 1062, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 721.51, "standard_charge_percentage": 42.0000, "estimated_amount": 721, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1593.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1593, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1593.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1593, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 721.51, "standard_charge_percentage": 42.0000, "estimated_amount": 721, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 743.82, "standard_charge_percentage": 42.0000, "estimated_amount": 743, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 736.38, "standard_charge_percentage": 42.0000, "estimated_amount": 736, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1505.35, "standard_charge_percentage": 85.0000, "estimated_amount": 1505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 743.82, "standard_charge_percentage": 42.0000, "estimated_amount": 743, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 885.5, "standard_charge_percentage": 50.0000, "estimated_amount": 885, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1593.9, "standard_charge_percentage": 90.0000, "estimated_amount": 1593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1549.63, "standard_charge_percentage": 87.5000, "estimated_amount": 1549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1328.25, "standard_charge_percentage": 75.0000, "estimated_amount": 1328, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1416.8, "standard_charge_percentage": 80.0000, "estimated_amount": 1416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 706.63, "standard_charge_percentage": 42.0000, "estimated_amount": 706, "methodology": "percent of total billed charges" }]}]} , { "description": "Pinch graft up to 2 cm diam", "code_information": [ { "code": "15050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2143.35, "discounted_cash": 868,"minimum": 256.43,"maximum": 2143.35,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 701.19, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1500.35, "standard_charge_percentage": 70.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 593.67, "estimated_amount": 593, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2036.18, "standard_charge_percentage": 95.0000, "estimated_amount": 2036, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1929.02, "standard_charge_percentage": 90.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 891.2, "standard_charge_percentage": 42.0000, "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2143.35, "estimated_amount": 2143, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1500.35, "standard_charge_percentage": 70.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 711.87, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1875.43, "standard_charge_percentage": 87.5000, "estimated_amount": 1875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 934.92, "estimated_amount": 934, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1929.02, "standard_charge_percentage": 90.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1929.02, "standard_charge_percentage": 90.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1607.51, "standard_charge_percentage": 75.0000, "estimated_amount": 1607, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1071.67, "standard_charge_percentage": 50.0000, "estimated_amount": 1071, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 900.21, "standard_charge_percentage": 42.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1500.35, "standard_charge_percentage": 70.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1046.6, "standard_charge_percentage": 48.8300, "estimated_amount": 1046, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 900.21, "standard_charge_percentage": 42.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 681.16, "estimated_amount": 681, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 643, "standard_charge_percentage": 30.0000, "estimated_amount": 643, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 855.2, "standard_charge_percentage": 42.0000, "estimated_amount": 855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 855.2, "standard_charge_percentage": 42.0000, "estimated_amount": 855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1286.01, "standard_charge_percentage": 60.0000, "estimated_amount": 1286, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1821.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 667.8, "estimated_amount": 667, "methodology": "fee schedule" }]}]} , { "description": "Epidrm autogrft trnkarmleg", "code_information": [ { "code": "15110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7056.05, "discounted_cash": 2594,"minimum": 256.43,"maximum": 6703.25,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2815.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6703.25, "standard_charge_percentage": 95.0000, "estimated_amount": 6703, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4233.63, "standard_charge_percentage": 60.0000, "estimated_amount": 4233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2674.68, "estimated_amount": 2674, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2116.82, "standard_charge_percentage": 30.0000, "estimated_amount": 2116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1587.93, "estimated_amount": 1587, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2793.85, "estimated_amount": 2793, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3528.03, "standard_charge_percentage": 50.0000, "estimated_amount": 3528, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6174.04, "standard_charge_percentage": 87.5000, "estimated_amount": 6174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5292.04, "standard_charge_percentage": 75.0000, "estimated_amount": 5292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2095.39, "estimated_amount": 2095, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1774.1, "estimated_amount": 1774, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2815.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2963.54, "standard_charge_percentage": 42.0000, "estimated_amount": 2963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2127.32, "estimated_amount": 2127, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3445.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3445, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2933.91, "standard_charge_percentage": 42.0000, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2963.54, "standard_charge_percentage": 42.0000, "estimated_amount": 2963, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5997.64, "standard_charge_percentage": 85.0000, "estimated_amount": 5997, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" }]}]} , { "description": "INJ NEUROLYT; EPID LUMB/CAUDAL", "code_information": [ { "code": "15111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2630.25,"minimum": 282,"maximum": 2630.25,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2104, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2367.22, "standard_charge_percentage": 90.0000, "estimated_amount": 2367, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2104, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1315.13, "standard_charge_percentage": 50.0000, "estimated_amount": 1315, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 789.08, "standard_charge_percentage": 30.0000, "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1841.17, "standard_charge_percentage": 70.0000, "estimated_amount": 1841, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2104, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1071.56, "standard_charge_percentage": 42.0000, "estimated_amount": 1071, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2104, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2104, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1049.47, "standard_charge_percentage": 42.0000, "estimated_amount": 1049, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1841.17, "standard_charge_percentage": 70.0000, "estimated_amount": 1841, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2104, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2104, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1578.15, "standard_charge_percentage": 60.0000, "estimated_amount": 1578, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2630.25, "estimated_amount": 2630, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2301.47, "standard_charge_percentage": 87.5000, "estimated_amount": 2301, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1049.47, "standard_charge_percentage": 42.0000, "estimated_amount": 1049, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1071.56, "standard_charge_percentage": 42.0000, "estimated_amount": 1071, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2235.71, "standard_charge_percentage": 85.0000, "estimated_amount": 2235, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1071.56, "standard_charge_percentage": 42.0000, "estimated_amount": 1071, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2104, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1071.56, "standard_charge_percentage": 42.0000, "estimated_amount": 1071, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1841.17, "standard_charge_percentage": 70.0000, "estimated_amount": 1841, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1972.69, "standard_charge_percentage": 75.0000, "estimated_amount": 1972, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2367.22, "standard_charge_percentage": 90.0000, "estimated_amount": 2367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1104.7, "standard_charge_percentage": 42.0000, "estimated_amount": 1104, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1093.66, "standard_charge_percentage": 42.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2498.74, "standard_charge_percentage": 95.0000, "estimated_amount": 2498, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1104.7, "standard_charge_percentage": 42.0000, "estimated_amount": 1104, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2104, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2367.22, "standard_charge_percentage": 90.0000, "estimated_amount": 2367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2104.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2104, "methodology": "percent of total billed charges" }]}]} , { "description": "Epidrm a-grft facenckhfg", "code_information": [ { "code": "15115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7056.05, "discounted_cash": 2594,"minimum": 416.37,"maximum": 6703.25,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3445.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4233.63, "standard_charge_percentage": 60.0000, "estimated_amount": 4233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2933.91, "standard_charge_percentage": 42.0000, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6703.25, "standard_charge_percentage": 95.0000, "estimated_amount": 6703, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5292.04, "standard_charge_percentage": 75.0000, "estimated_amount": 5292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2963.54, "standard_charge_percentage": 42.0000, "estimated_amount": 2963, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2793.85, "estimated_amount": 2793, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2815.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2815, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2963.54, "standard_charge_percentage": 42.0000, "estimated_amount": 2963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5997.64, "standard_charge_percentage": 85.0000, "estimated_amount": 5997, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2095.39, "estimated_amount": 2095, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3528.03, "standard_charge_percentage": 50.0000, "estimated_amount": 3528, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1774.1, "estimated_amount": 1774, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2127.32, "estimated_amount": 2127, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6174.04, "standard_charge_percentage": 87.5000, "estimated_amount": 6174, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2116.82, "standard_charge_percentage": 30.0000, "estimated_amount": 2116, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2815.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1587.93, "estimated_amount": 1587, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2674.68, "estimated_amount": 2674, "methodology": "case rate" }]}]} , { "description": "INJECT INTO DISK LESION", "code_information": [ { "code": "15116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1501.19,"minimum": 282,"maximum": 1501.19,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 611.58, "standard_charge_percentage": 42.0000, "estimated_amount": 611, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 630.5, "standard_charge_percentage": 42.0000, "estimated_amount": 630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1050.83, "standard_charge_percentage": 70.0000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 611.58, "standard_charge_percentage": 42.0000, "estimated_amount": 611, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1276.01, "standard_charge_percentage": 85.0000, "estimated_amount": 1276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 598.97, "standard_charge_percentage": 42.0000, "estimated_amount": 598, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 630.5, "standard_charge_percentage": 42.0000, "estimated_amount": 630, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 611.58, "standard_charge_percentage": 42.0000, "estimated_amount": 611, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1351.07, "standard_charge_percentage": 90.0000, "estimated_amount": 1351, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1313.54, "standard_charge_percentage": 87.5000, "estimated_amount": 1313, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1351.07, "standard_charge_percentage": 90.0000, "estimated_amount": 1351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 900.71, "standard_charge_percentage": 60.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1426.13, "standard_charge_percentage": 95.0000, "estimated_amount": 1426, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1501.19, "estimated_amount": 1501, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 598.97, "standard_charge_percentage": 42.0000, "estimated_amount": 598, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1125.89, "standard_charge_percentage": 75.0000, "estimated_amount": 1125, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 624.19, "standard_charge_percentage": 42.0000, "estimated_amount": 624, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 416.37, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 750.6, "standard_charge_percentage": 50.0000, "estimated_amount": 750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 450.36, "standard_charge_percentage": 30.0000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1050.83, "standard_charge_percentage": 70.0000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1351.07, "standard_charge_percentage": 90.0000, "estimated_amount": 1351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1050.83, "standard_charge_percentage": 70.0000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1200.95, "standard_charge_percentage": 80.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 611.58, "standard_charge_percentage": 42.0000, "estimated_amount": 611, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Split Grft,Head,Fac,Hand,Feet <100 Sqcm", "code_information": [ { "code": "15120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10687.5, "discounted_cash": 5192,"minimum": 1045.33,"maximum": 10153.1,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 7481.25, "standard_charge_percentage": 70.0000, "estimated_amount": 7481, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5591.56, "estimated_amount": 5591, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 7481.25, "standard_charge_percentage": 70.0000, "estimated_amount": 7481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 8015.63, "standard_charge_percentage": 75.0000, "estimated_amount": 8015, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 9351.56, "standard_charge_percentage": 87.5000, "estimated_amount": 9351, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5343.75, "standard_charge_percentage": 50.0000, "estimated_amount": 5343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4073.85, "estimated_amount": 4073, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4051.2, "estimated_amount": 4051, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 9618.75, "standard_charge_percentage": 90.0000, "estimated_amount": 9618, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 4264.31, "standard_charge_percentage": 42.0000, "estimated_amount": 4264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1979.7, "estimated_amount": 1979, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 10153.1, "standard_charge_percentage": 95.0000, "estimated_amount": 10153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4443.86, "standard_charge_percentage": 42.0000, "estimated_amount": 4443, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4488.75, "standard_charge_percentage": 42.0000, "estimated_amount": 4488, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4488.75, "standard_charge_percentage": 42.0000, "estimated_amount": 4488, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5218.71, "standard_charge_percentage": 48.8300, "estimated_amount": 5218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 7481.25, "standard_charge_percentage": 70.0000, "estimated_amount": 7481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3550.64, "estimated_amount": 3550, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 4264.31, "standard_charge_percentage": 42.0000, "estimated_amount": 4264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 4257.57, "estimated_amount": 4257, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 9618.75, "standard_charge_percentage": 90.0000, "estimated_amount": 9618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3206.25, "standard_charge_percentage": 30.0000, "estimated_amount": 3206, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 9618.75, "standard_charge_percentage": 90.0000, "estimated_amount": 9618, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2405.16, "estimated_amount": 2405, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1979.7, "estimated_amount": 1979, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6412.5, "standard_charge_percentage": 60.0000, "estimated_amount": 6412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 4193.67, "estimated_amount": 4193, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 4073.85, "estimated_amount": 4073, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5854, "estimated_amount": 5854, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1287, "estimated_amount": 1287, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 9084.38, "standard_charge_percentage": 85.0000, "estimated_amount": 9084, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" }]}]} , { "description": "I&D COMPLEX WOUND INFEC POSTOP", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7056.05, "discounted_cash": 2594,"minimum": 256.43,"maximum": 6703.25,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1587.93, "estimated_amount": 1587, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1774.1, "estimated_amount": 1774, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 304.04, "estimated_amount": 304, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2793.85, "estimated_amount": 2793, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5997.64, "standard_charge_percentage": 85.0000, "estimated_amount": 5997, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2674.68, "estimated_amount": 2674, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2963.54, "standard_charge_percentage": 42.0000, "estimated_amount": 2963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2815.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2815, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2933.91, "standard_charge_percentage": 42.0000, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2127.32, "estimated_amount": 2127, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4233.63, "standard_charge_percentage": 60.0000, "estimated_amount": 4233, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6703.25, "standard_charge_percentage": 95.0000, "estimated_amount": 6703, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6174.04, "standard_charge_percentage": 87.5000, "estimated_amount": 6174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 304.04, "estimated_amount": 304, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3445.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2116.82, "standard_charge_percentage": 30.0000, "estimated_amount": 2116, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3528.03, "standard_charge_percentage": 50.0000, "estimated_amount": 3528, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5292.04, "standard_charge_percentage": 75.0000, "estimated_amount": 5292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2963.54, "standard_charge_percentage": 42.0000, "estimated_amount": 2963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2095.39, "estimated_amount": 2095, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2815.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2815, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" }]}]} , { "description": "D-19 BIOPSY SKIN LESION", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 507.5,"minimum": 112.05,"maximum": 507.5,"payers_information":[{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 431.38, "standard_charge_percentage": 85.0000, "estimated_amount": 431, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 355.25, "standard_charge_percentage": 70.0000, "estimated_amount": 355, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 406, "standard_charge_percentage": 80.0000, "estimated_amount": 406, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 406, "standard_charge_percentage": 80.0000, "estimated_amount": 406, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 206.76, "standard_charge_percentage": 42.0000, "estimated_amount": 206, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 456.75, "standard_charge_percentage": 90.0000, "estimated_amount": 456, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 444.06, "standard_charge_percentage": 87.5000, "estimated_amount": 444, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 152.25, "standard_charge_percentage": 30.0000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 202.49, "standard_charge_percentage": 42.0000, "estimated_amount": 202, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 213.15, "standard_charge_percentage": 42.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 406, "standard_charge_percentage": 80.0000, "estimated_amount": 406, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 211.02, "standard_charge_percentage": 42.0000, "estimated_amount": 211, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 456.75, "standard_charge_percentage": 90.0000, "estimated_amount": 456, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 406, "standard_charge_percentage": 80.0000, "estimated_amount": 406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 112.05, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 355.25, "standard_charge_percentage": 70.0000, "estimated_amount": 355, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 206.76, "standard_charge_percentage": 42.0000, "estimated_amount": 206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 355.25, "standard_charge_percentage": 70.0000, "estimated_amount": 355, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 507.5, "estimated_amount": 507, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 202.49, "standard_charge_percentage": 42.0000, "estimated_amount": 202, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 213.15, "standard_charge_percentage": 42.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 406, "standard_charge_percentage": 80.0000, "estimated_amount": 406, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 253.75, "standard_charge_percentage": 50.0000, "estimated_amount": 253, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 112.05, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 304.5, "standard_charge_percentage": 60.0000, "estimated_amount": 304, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 456.75, "standard_charge_percentage": 90.0000, "estimated_amount": 456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 380.63, "standard_charge_percentage": 75.0000, "estimated_amount": 380, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 406, "standard_charge_percentage": 80.0000, "estimated_amount": 406, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 206.76, "standard_charge_percentage": 42.0000, "estimated_amount": 206, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 406, "standard_charge_percentage": 80.0000, "estimated_amount": 406, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 406, "standard_charge_percentage": 80.0000, "estimated_amount": 406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 507.5, "estimated_amount": 507, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 406, "standard_charge_percentage": 80.0000, "estimated_amount": 406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 406, "standard_charge_percentage": 80.0000, "estimated_amount": 406, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 482.13, "standard_charge_percentage": 95.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 206.76, "standard_charge_percentage": 42.0000, "estimated_amount": 206, "methodology": "percent of total billed charges" }]}]} , { "description": "D-19 BX SKIN ADDL LESION", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10687.5, "discounted_cash": 5192,"minimum": 256.43,"maximum": 10153.1,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 4257.57, "estimated_amount": 4257, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 7481.25, "standard_charge_percentage": 70.0000, "estimated_amount": 7481, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4488.75, "standard_charge_percentage": 42.0000, "estimated_amount": 4488, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5343.75, "standard_charge_percentage": 50.0000, "estimated_amount": 5343, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 4264.31, "standard_charge_percentage": 42.0000, "estimated_amount": 4264, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4443.86, "standard_charge_percentage": 42.0000, "estimated_amount": 4443, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 9351.56, "standard_charge_percentage": 87.5000, "estimated_amount": 9351, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 7481.25, "standard_charge_percentage": 70.0000, "estimated_amount": 7481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 8015.63, "standard_charge_percentage": 75.0000, "estimated_amount": 8015, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 9084.38, "standard_charge_percentage": 85.0000, "estimated_amount": 9084, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 7481.25, "standard_charge_percentage": 70.0000, "estimated_amount": 7481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1287, "estimated_amount": 1287, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5591.56, "estimated_amount": 5591, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4051.2, "estimated_amount": 4051, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 9618.75, "standard_charge_percentage": 90.0000, "estimated_amount": 9618, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 463.04, "estimated_amount": 463, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 10153.1, "standard_charge_percentage": 95.0000, "estimated_amount": 10153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4073.85, "estimated_amount": 4073, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2405.16, "estimated_amount": 2405, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5854, "estimated_amount": 5854, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3206.25, "standard_charge_percentage": 30.0000, "estimated_amount": 3206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3550.64, "estimated_amount": 3550, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 9618.75, "standard_charge_percentage": 90.0000, "estimated_amount": 9618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 4264.31, "standard_charge_percentage": 42.0000, "estimated_amount": 4264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 4193.67, "estimated_amount": 4193, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6412.5, "standard_charge_percentage": 60.0000, "estimated_amount": 6412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3993.97, "estimated_amount": 3993, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 9618.75, "standard_charge_percentage": 90.0000, "estimated_amount": 9618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5218.71, "standard_charge_percentage": 48.8300, "estimated_amount": 5218, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 4073.85, "estimated_amount": 4073, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 463.04, "estimated_amount": 463, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4488.75, "standard_charge_percentage": 42.0000, "estimated_amount": 4488, "methodology": "percent of total billed charges" }]}]} , { "description": "LIGATURE HEMORRHOIDECTOMY", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1265.15,"minimum": 282,"maximum": 1265.15,"payers_information":[{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 632.58, "standard_charge_percentage": 50.0000, "estimated_amount": 632, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 504.79, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1201.89, "standard_charge_percentage": 95.0000, "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 504.79, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 515.42, "standard_charge_percentage": 42.0000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1138.64, "standard_charge_percentage": 90.0000, "estimated_amount": 1138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1265.15, "estimated_amount": 1265, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 885.61, "standard_charge_percentage": 70.0000, "estimated_amount": 885, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 515.42, "standard_charge_percentage": 42.0000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1138.64, "standard_charge_percentage": 90.0000, "estimated_amount": 1138, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1107.01, "standard_charge_percentage": 87.5000, "estimated_amount": 1107, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1075.38, "standard_charge_percentage": 85.0000, "estimated_amount": 1075, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 531.36, "standard_charge_percentage": 42.0000, "estimated_amount": 531, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 379.55, "standard_charge_percentage": 30.0000, "estimated_amount": 379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 531.36, "standard_charge_percentage": 42.0000, "estimated_amount": 531, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 304.04, "estimated_amount": 304, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1265.15, "estimated_amount": 1265, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 304.04, "estimated_amount": 304, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 885.61, "standard_charge_percentage": 70.0000, "estimated_amount": 885, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 515.42, "standard_charge_percentage": 42.0000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 948.86, "standard_charge_percentage": 75.0000, "estimated_amount": 948, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 759.09, "standard_charge_percentage": 60.0000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 526.05, "standard_charge_percentage": 42.0000, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1138.64, "standard_charge_percentage": 90.0000, "estimated_amount": 1138, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 885.61, "standard_charge_percentage": 70.0000, "estimated_amount": 885, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 515.42, "standard_charge_percentage": 42.0000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" }]}]} , { "description": "BIOPSY, THYROID", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7056.05, "discounted_cash": 2594,"minimum": 256.43,"maximum": 6703.25,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 304.04, "estimated_amount": 304, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2116.82, "standard_charge_percentage": 30.0000, "estimated_amount": 2116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2933.91, "standard_charge_percentage": 42.0000, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6174.04, "standard_charge_percentage": 87.5000, "estimated_amount": 6174, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6703.25, "standard_charge_percentage": 95.0000, "estimated_amount": 6703, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2674.68, "estimated_amount": 2674, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1587.93, "estimated_amount": 1587, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5997.64, "standard_charge_percentage": 85.0000, "estimated_amount": 5997, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2127.32, "estimated_amount": 2127, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4233.63, "standard_charge_percentage": 60.0000, "estimated_amount": 4233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3528.03, "standard_charge_percentage": 50.0000, "estimated_amount": 3528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 304.04, "estimated_amount": 304, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2095.39, "estimated_amount": 2095, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5292.04, "standard_charge_percentage": 75.0000, "estimated_amount": 5292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2793.85, "estimated_amount": 2793, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1774.1, "estimated_amount": 1774, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2815.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3445.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2815.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2815, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2963.54, "standard_charge_percentage": 42.0000, "estimated_amount": 2963, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2963.54, "standard_charge_percentage": 42.0000, "estimated_amount": 2963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" }]}]} , { "description": "ASPIRATE/INJECT THYROID CYST", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 670.4,"minimum": 112.05,"maximum": 670.4,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 267.49, "standard_charge_percentage": 42.0000, "estimated_amount": 267, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 273.12, "standard_charge_percentage": 42.0000, "estimated_amount": 273, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 586.6, "standard_charge_percentage": 87.5000, "estimated_amount": 586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 536.32, "standard_charge_percentage": 80.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 636.88, "standard_charge_percentage": 95.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 536.32, "standard_charge_percentage": 80.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 536.32, "standard_charge_percentage": 80.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 469.28, "standard_charge_percentage": 70.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 536.32, "standard_charge_percentage": 80.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 502.8, "standard_charge_percentage": 75.0000, "estimated_amount": 502, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 281.57, "standard_charge_percentage": 42.0000, "estimated_amount": 281, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 536.32, "standard_charge_percentage": 80.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 112.05, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 112.05, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 278.75, "standard_charge_percentage": 42.0000, "estimated_amount": 278, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 469.28, "standard_charge_percentage": 70.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 603.36, "standard_charge_percentage": 90.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 273.12, "standard_charge_percentage": 42.0000, "estimated_amount": 273, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 536.32, "standard_charge_percentage": 80.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 536.32, "standard_charge_percentage": 80.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 670.4, "estimated_amount": 670, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 536.32, "standard_charge_percentage": 80.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 670.4, "estimated_amount": 670, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 201.12, "standard_charge_percentage": 30.0000, "estimated_amount": 201, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 273.12, "standard_charge_percentage": 42.0000, "estimated_amount": 273, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 536.32, "standard_charge_percentage": 80.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 335.2, "standard_charge_percentage": 50.0000, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 536.32, "standard_charge_percentage": 80.0000, "estimated_amount": 536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 281.57, "standard_charge_percentage": 42.0000, "estimated_amount": 281, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 569.84, "standard_charge_percentage": 85.0000, "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 402.24, "standard_charge_percentage": 60.0000, "estimated_amount": 402, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 273.12, "standard_charge_percentage": 42.0000, "estimated_amount": 273, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 603.36, "standard_charge_percentage": 90.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 267.49, "standard_charge_percentage": 42.0000, "estimated_amount": 267, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 603.36, "standard_charge_percentage": 90.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 469.28, "standard_charge_percentage": 70.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" }]}]} , { "description": "ASPIRATION/INJECTION THYROID C", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10687.5, "discounted_cash": 2594,"minimum": 256.43,"maximum": 10153.1,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2127.32, "estimated_amount": 2127, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 7481.25, "standard_charge_percentage": 70.0000, "estimated_amount": 7481, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 9618.75, "standard_charge_percentage": 90.0000, "estimated_amount": 9618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4051.2, "estimated_amount": 4051, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2405.16, "estimated_amount": 2405, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5343.75, "standard_charge_percentage": 50.0000, "estimated_amount": 5343, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 9084.38, "standard_charge_percentage": 85.0000, "estimated_amount": 9084, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 9618.75, "standard_charge_percentage": 90.0000, "estimated_amount": 9618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4488.75, "standard_charge_percentage": 42.0000, "estimated_amount": 4488, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 7481.25, "standard_charge_percentage": 70.0000, "estimated_amount": 7481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 463.04, "estimated_amount": 463, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 463.04, "estimated_amount": 463, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3206.25, "standard_charge_percentage": 30.0000, "estimated_amount": 3206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1774.1, "estimated_amount": 1774, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 4264.31, "standard_charge_percentage": 42.0000, "estimated_amount": 4264, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4443.86, "standard_charge_percentage": 42.0000, "estimated_amount": 4443, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 9351.56, "standard_charge_percentage": 87.5000, "estimated_amount": 9351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6412.5, "standard_charge_percentage": 60.0000, "estimated_amount": 6412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2095.39, "estimated_amount": 2095, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5218.71, "standard_charge_percentage": 48.8300, "estimated_amount": 5218, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 4264.31, "standard_charge_percentage": 42.0000, "estimated_amount": 4264, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 9618.75, "standard_charge_percentage": 90.0000, "estimated_amount": 9618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 10153.1, "standard_charge_percentage": 95.0000, "estimated_amount": 10153, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 7481.25, "standard_charge_percentage": 70.0000, "estimated_amount": 7481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 8015.63, "standard_charge_percentage": 75.0000, "estimated_amount": 8015, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4488.75, "standard_charge_percentage": 42.0000, "estimated_amount": 4488, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2793.85, "estimated_amount": 2793, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" }]}]} , { "description": "NEEDLE BX MUSCLE/SOFT TISSUE", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1265.15,"minimum": 282,"maximum": 1265.15,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 515.42, "standard_charge_percentage": 42.0000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 759.09, "standard_charge_percentage": 60.0000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1075.38, "standard_charge_percentage": 85.0000, "estimated_amount": 1075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 304.04, "estimated_amount": 304, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 885.61, "standard_charge_percentage": 70.0000, "estimated_amount": 885, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 531.36, "standard_charge_percentage": 42.0000, "estimated_amount": 531, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 504.79, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 515.42, "standard_charge_percentage": 42.0000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 526.05, "standard_charge_percentage": 42.0000, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 885.61, "standard_charge_percentage": 70.0000, "estimated_amount": 885, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 632.58, "standard_charge_percentage": 50.0000, "estimated_amount": 632, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1138.64, "standard_charge_percentage": 90.0000, "estimated_amount": 1138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 531.36, "standard_charge_percentage": 42.0000, "estimated_amount": 531, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 304.04, "estimated_amount": 304, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 515.42, "standard_charge_percentage": 42.0000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1107.01, "standard_charge_percentage": 87.5000, "estimated_amount": 1107, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 885.61, "standard_charge_percentage": 70.0000, "estimated_amount": 885, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1201.89, "standard_charge_percentage": 95.0000, "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 515.42, "standard_charge_percentage": 42.0000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 504.79, "standard_charge_percentage": 42.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 379.55, "standard_charge_percentage": 30.0000, "estimated_amount": 379, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1138.64, "standard_charge_percentage": 90.0000, "estimated_amount": 1138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1265.15, "estimated_amount": 1265, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1138.64, "standard_charge_percentage": 90.0000, "estimated_amount": 1138, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1012.12, "standard_charge_percentage": 80.0000, "estimated_amount": 1012, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1265.15, "estimated_amount": 1265, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 948.86, "standard_charge_percentage": 75.0000, "estimated_amount": 948, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Abrasion, Single", "code_information": [ { "code": "15786", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.15, "discounted_cash": 281,"minimum": 59.05,"maximum": 589.15,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 515.51, "standard_charge_percentage": 87.5000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 559.69, "standard_charge_percentage": 95.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 235.07, "standard_charge_percentage": 42.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 353.49, "standard_charge_percentage": 60.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 294.57, "standard_charge_percentage": 50.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 176.75, "standard_charge_percentage": 30.0000, "estimated_amount": 176, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 441.86, "standard_charge_percentage": 75.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 287.68, "standard_charge_percentage": 48.8300, "estimated_amount": 287, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 247.44, "standard_charge_percentage": 42.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 247.44, "standard_charge_percentage": 42.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 235.07, "standard_charge_percentage": 42.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 59.05, "estimated_amount": 59, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 131.89, "estimated_amount": 131, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 500.78, "standard_charge_percentage": 85.0000, "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 244.97, "standard_charge_percentage": 42.0000, "estimated_amount": 244, "methodology": "percent of total billed charges" }]}]} , { "description": "36115853", "code_information": [ { "code": "15853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4675,"minimum": 282,"maximum": 4441.25,"payers_information":[{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4090.63, "standard_charge_percentage": 87.5000, "estimated_amount": 4090, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3740, "standard_charge_percentage": 80.0000, "estimated_amount": 3740, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1963.5, "standard_charge_percentage": 42.0000, "estimated_amount": 1963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3740, "standard_charge_percentage": 80.0000, "estimated_amount": 3740, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2805, "standard_charge_percentage": 60.0000, "estimated_amount": 2805, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3740, "standard_charge_percentage": 80.0000, "estimated_amount": 3740, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1904.6, "standard_charge_percentage": 42.0000, "estimated_amount": 1904, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1963.5, "standard_charge_percentage": 42.0000, "estimated_amount": 1963, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3740, "standard_charge_percentage": 80.0000, "estimated_amount": 3740, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4207.5, "standard_charge_percentage": 90.0000, "estimated_amount": 4207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2282.8, "standard_charge_percentage": 48.8300, "estimated_amount": 2282, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4441.25, "standard_charge_percentage": 95.0000, "estimated_amount": 4441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1865.32, "standard_charge_percentage": 42.0000, "estimated_amount": 1865, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3740, "standard_charge_percentage": 80.0000, "estimated_amount": 3740, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3272.5, "standard_charge_percentage": 70.0000, "estimated_amount": 3272, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3740, "standard_charge_percentage": 80.0000, "estimated_amount": 3740, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1865.32, "standard_charge_percentage": 42.0000, "estimated_amount": 1865, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3740, "standard_charge_percentage": 80.0000, "estimated_amount": 3740, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1168.75, "standard_charge_percentage": 25.0000, "estimated_amount": 1168, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1904.6, "standard_charge_percentage": 42.0000, "estimated_amount": 1904, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1402.5, "standard_charge_percentage": 30.0000, "estimated_amount": 1402, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2337.5, "standard_charge_percentage": 50.0000, "estimated_amount": 2337, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3132.25, "standard_charge_percentage": 67.0000, "estimated_amount": 3132, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1904.6, "standard_charge_percentage": 42.0000, "estimated_amount": 1904, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3506.25, "standard_charge_percentage": 75.0000, "estimated_amount": 3506, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4207.5, "standard_charge_percentage": 90.0000, "estimated_amount": 4207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3272.5, "standard_charge_percentage": 70.0000, "estimated_amount": 3272, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3740, "standard_charge_percentage": 80.0000, "estimated_amount": 3740, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3740, "standard_charge_percentage": 80.0000, "estimated_amount": 3740, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3272.5, "standard_charge_percentage": 70.0000, "estimated_amount": 3272, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 2337.5, "standard_charge_percentage": 50.0000, "estimated_amount": 2337, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1943.87, "standard_charge_percentage": 42.0000, "estimated_amount": 1943, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4207.5, "standard_charge_percentage": 90.0000, "estimated_amount": 4207, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 3973.75, "standard_charge_percentage": 85.0000, "estimated_amount": 3973, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1904.6, "standard_charge_percentage": 42.0000, "estimated_amount": 1904, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3740, "standard_charge_percentage": 80.0000, "estimated_amount": 3740, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Treat Burn 1St Degree, Initial", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.15, "discounted_cash": 281,"minimum": 77.81,"maximum": 589.15,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 441.86, "standard_charge_percentage": 75.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 247.44, "standard_charge_percentage": 42.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 287.68, "standard_charge_percentage": 48.8300, "estimated_amount": 287, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 294.57, "standard_charge_percentage": 50.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 500.78, "standard_charge_percentage": 85.0000, "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 353.49, "standard_charge_percentage": 60.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 515.51, "standard_charge_percentage": 87.5000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 559.69, "standard_charge_percentage": 95.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 176.75, "standard_charge_percentage": 30.0000, "estimated_amount": 176, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 235.07, "standard_charge_percentage": 42.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 247.44, "standard_charge_percentage": 42.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 244.97, "standard_charge_percentage": 42.0000, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 235.07, "standard_charge_percentage": 42.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" }]}]} , { "description": "Hc Dress/Debride Burn <5% Total Sm", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1920, "discounted_cash": 281,"minimum": 112.04,"maximum": 1920,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 782.21, "standard_charge_percentage": 42.0000, "estimated_amount": 782, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 142.57, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 782.21, "standard_charge_percentage": 42.0000, "estimated_amount": 782, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 142.57, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1728, "standard_charge_percentage": 90.0000, "estimated_amount": 1728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1920, "estimated_amount": 1920, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1152, "standard_charge_percentage": 60.0000, "estimated_amount": 1152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 576, "standard_charge_percentage": 30.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 806.4, "standard_charge_percentage": 42.0000, "estimated_amount": 806, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1440, "standard_charge_percentage": 75.0000, "estimated_amount": 1440, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1728, "standard_charge_percentage": 90.0000, "estimated_amount": 1728, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1344, "standard_charge_percentage": 70.0000, "estimated_amount": 1344, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1824, "standard_charge_percentage": 95.0000, "estimated_amount": 1824, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1344, "standard_charge_percentage": 70.0000, "estimated_amount": 1344, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1344, "standard_charge_percentage": 70.0000, "estimated_amount": 1344, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 782.21, "standard_charge_percentage": 42.0000, "estimated_amount": 782, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1680, "standard_charge_percentage": 87.5000, "estimated_amount": 1680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 806.4, "standard_charge_percentage": 42.0000, "estimated_amount": 806, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 960, "standard_charge_percentage": 50.0000, "estimated_amount": 960, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 782.21, "standard_charge_percentage": 42.0000, "estimated_amount": 782, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 766.08, "standard_charge_percentage": 42.0000, "estimated_amount": 766, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 937.54, "standard_charge_percentage": 48.8300, "estimated_amount": 937, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1632, "standard_charge_percentage": 85.0000, "estimated_amount": 1632, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1536, "standard_charge_percentage": 80.0000, "estimated_amount": 1536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 766.08, "standard_charge_percentage": 42.0000, "estimated_amount": 766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 798.34, "standard_charge_percentage": 42.0000, "estimated_amount": 798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1728, "standard_charge_percentage": 90.0000, "estimated_amount": 1728, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Dress/Debride Burn 5-10% Ttl Med", "code_information": [ { "code": "16025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 637, "discounted_cash": 281,"minimum": 112.04,"maximum": 637,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 259.51, "standard_charge_percentage": 42.0000, "estimated_amount": 259, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 637, "estimated_amount": 637, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 142.57, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 259.51, "standard_charge_percentage": 42.0000, "estimated_amount": 259, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 509.6, "standard_charge_percentage": 80.0000, "estimated_amount": 509, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 477.75, "standard_charge_percentage": 75.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 509.6, "standard_charge_percentage": 80.0000, "estimated_amount": 509, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 557.38, "standard_charge_percentage": 87.5000, "estimated_amount": 557, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 191.1, "standard_charge_percentage": 30.0000, "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 142.57, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 259.51, "standard_charge_percentage": 42.0000, "estimated_amount": 259, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 509.6, "standard_charge_percentage": 80.0000, "estimated_amount": 509, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 637, "estimated_amount": 637, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 509.6, "standard_charge_percentage": 80.0000, "estimated_amount": 509, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 259.51, "standard_charge_percentage": 42.0000, "estimated_amount": 259, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 264.86, "standard_charge_percentage": 42.0000, "estimated_amount": 264, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 509.6, "standard_charge_percentage": 80.0000, "estimated_amount": 509, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 445.9, "standard_charge_percentage": 70.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 541.45, "standard_charge_percentage": 85.0000, "estimated_amount": 541, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 605.15, "standard_charge_percentage": 95.0000, "estimated_amount": 605, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 573.3, "standard_charge_percentage": 90.0000, "estimated_amount": 573, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 254.16, "standard_charge_percentage": 42.0000, "estimated_amount": 254, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 445.9, "standard_charge_percentage": 70.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 267.54, "standard_charge_percentage": 42.0000, "estimated_amount": 267, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 509.6, "standard_charge_percentage": 80.0000, "estimated_amount": 509, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 311.05, "standard_charge_percentage": 48.8300, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 509.6, "standard_charge_percentage": 80.0000, "estimated_amount": 509, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 254.16, "standard_charge_percentage": 42.0000, "estimated_amount": 254, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 509.6, "standard_charge_percentage": 80.0000, "estimated_amount": 509, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 509.6, "standard_charge_percentage": 80.0000, "estimated_amount": 509, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 445.9, "standard_charge_percentage": 70.0000, "estimated_amount": 445, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 573.3, "standard_charge_percentage": 90.0000, "estimated_amount": 573, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 318.5, "standard_charge_percentage": 50.0000, "estimated_amount": 318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 382.2, "standard_charge_percentage": 60.0000, "estimated_amount": 382, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 573.3, "standard_charge_percentage": 90.0000, "estimated_amount": 573, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 509.6, "standard_charge_percentage": 80.0000, "estimated_amount": 509, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 267.54, "standard_charge_percentage": 42.0000, "estimated_amount": 267, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" }]}]} , { "description": "Dressdebrid p-thick burn l", "code_information": [ { "code": "16030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 703, "discounted_cash": 566,"minimum": 112.04,"maximum": 703,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 286.4, "standard_charge_percentage": 42.0000, "estimated_amount": 286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 562.4, "standard_charge_percentage": 80.0000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 286.4, "standard_charge_percentage": 42.0000, "estimated_amount": 286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 492.1, "standard_charge_percentage": 70.0000, "estimated_amount": 492, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 295.26, "standard_charge_percentage": 42.0000, "estimated_amount": 295, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 562.4, "standard_charge_percentage": 80.0000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 295.26, "standard_charge_percentage": 42.0000, "estimated_amount": 295, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 562.4, "standard_charge_percentage": 80.0000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 562.4, "standard_charge_percentage": 80.0000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 286.4, "standard_charge_percentage": 42.0000, "estimated_amount": 286, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 292.31, "standard_charge_percentage": 42.0000, "estimated_amount": 292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 703, "estimated_amount": 703, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 632.7, "standard_charge_percentage": 90.0000, "estimated_amount": 632, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 286.4, "standard_charge_percentage": 42.0000, "estimated_amount": 286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 280.5, "standard_charge_percentage": 42.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 210.9, "standard_charge_percentage": 30.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 527.25, "standard_charge_percentage": 75.0000, "estimated_amount": 527, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 562.4, "standard_charge_percentage": 80.0000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 632.7, "standard_charge_percentage": 90.0000, "estimated_amount": 632, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 351.5, "standard_charge_percentage": 50.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 492.1, "standard_charge_percentage": 70.0000, "estimated_amount": 492, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 562.4, "standard_charge_percentage": 80.0000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 142.57, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 667.85, "standard_charge_percentage": 95.0000, "estimated_amount": 667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 421.8, "standard_charge_percentage": 60.0000, "estimated_amount": 421, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 562.4, "standard_charge_percentage": 80.0000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 343.27, "standard_charge_percentage": 48.8300, "estimated_amount": 343, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 615.13, "standard_charge_percentage": 87.5000, "estimated_amount": 615, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 632.7, "standard_charge_percentage": 90.0000, "estimated_amount": 632, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 562.4, "standard_charge_percentage": 80.0000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 562.4, "standard_charge_percentage": 80.0000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 703, "estimated_amount": 703, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 562.4, "standard_charge_percentage": 80.0000, "estimated_amount": 562, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 492.1, "standard_charge_percentage": 70.0000, "estimated_amount": 492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 597.55, "standard_charge_percentage": 85.0000, "estimated_amount": 597, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 142.57, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 280.5, "standard_charge_percentage": 42.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" }]}]} , { "description": "Hc Escharotomy", "code_information": [ { "code": "16035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2143.35, "discounted_cash": 566,"minimum": 112.04,"maximum": 2143.35,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 891.2, "standard_charge_percentage": 42.0000, "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1500.35, "standard_charge_percentage": 70.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 855.2, "standard_charge_percentage": 42.0000, "estimated_amount": 855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1500.35, "standard_charge_percentage": 70.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1500.35, "standard_charge_percentage": 70.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1071.67, "standard_charge_percentage": 50.0000, "estimated_amount": 1071, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 643, "standard_charge_percentage": 30.0000, "estimated_amount": 643, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 482.36, "estimated_amount": 482, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1875.43, "standard_charge_percentage": 87.5000, "estimated_amount": 1875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1046.6, "standard_charge_percentage": 48.8300, "estimated_amount": 1046, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1929.02, "standard_charge_percentage": 90.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1929.02, "standard_charge_percentage": 90.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2036.18, "standard_charge_percentage": 95.0000, "estimated_amount": 2036, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1929.02, "standard_charge_percentage": 90.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2143.35, "estimated_amount": 2143, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 142.57, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 873.2, "standard_charge_percentage": 42.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 855.2, "standard_charge_percentage": 42.0000, "estimated_amount": 855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 900.21, "standard_charge_percentage": 42.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1821.85, "standard_charge_percentage": 85.0000, "estimated_amount": 1821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1607.51, "standard_charge_percentage": 75.0000, "estimated_amount": 1607, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1286.01, "standard_charge_percentage": 60.0000, "estimated_amount": 1286, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 142.57, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 900.21, "standard_charge_percentage": 42.0000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 812.46, "estimated_amount": 812, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1714.68, "standard_charge_percentage": 80.0000, "estimated_amount": 1714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" }]}]} , { "description": "Hc Destruc Benign/Premal,First Lesion", "code_information": [ { "code": "17000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.15, "discounted_cash": 281,"minimum": 59.05,"maximum": 589.15,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 247.44, "standard_charge_percentage": 42.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 515.51, "standard_charge_percentage": 87.5000, "estimated_amount": 515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 59.05, "estimated_amount": 59, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 244.97, "standard_charge_percentage": 42.0000, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 559.69, "standard_charge_percentage": 95.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 287.68, "standard_charge_percentage": 48.8300, "estimated_amount": 287, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 353.49, "standard_charge_percentage": 60.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 240.02, "standard_charge_percentage": 42.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 235.07, "standard_charge_percentage": 42.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 176.75, "standard_charge_percentage": 30.0000, "estimated_amount": 176, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 441.86, "standard_charge_percentage": 75.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 412.4, "standard_charge_percentage": 70.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 530.24, "standard_charge_percentage": 90.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 589.15, "estimated_amount": 589, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 247.44, "standard_charge_percentage": 42.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 235.07, "standard_charge_percentage": 42.0000, "estimated_amount": 235, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 294.57, "standard_charge_percentage": 50.0000, "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 500.78, "standard_charge_percentage": 85.0000, "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 471.32, "standard_charge_percentage": 80.0000, "estimated_amount": 471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 131.89, "estimated_amount": 131, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" }]}]} , { "description": "Hc Destruc Benign/Premal,2-14 Lesions", "code_information": [ { "code": "17003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108,"minimum": 32.4,"maximum": 108,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 44, "standard_charge_percentage": 42.0000, "estimated_amount": 44, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 45.36, "standard_charge_percentage": 42.0000, "estimated_amount": 45, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 39.3, "estimated_amount": 39, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 75.6, "standard_charge_percentage": 70.0000, "estimated_amount": 75, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 102.6, "standard_charge_percentage": 95.0000, "estimated_amount": 102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 54, "standard_charge_percentage": 50.0000, "estimated_amount": 54, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 81, "standard_charge_percentage": 75.0000, "estimated_amount": 81, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 64.8, "standard_charge_percentage": 60.0000, "estimated_amount": 64, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 32.4, "standard_charge_percentage": 30.0000, "estimated_amount": 32, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 94.5, "standard_charge_percentage": 87.5000, "estimated_amount": 94, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 97.2, "standard_charge_percentage": 90.0000, "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 45.36, "standard_charge_percentage": 42.0000, "estimated_amount": 45, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 39.3, "estimated_amount": 39, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 75.6, "standard_charge_percentage": 70.0000, "estimated_amount": 75, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 43.09, "standard_charge_percentage": 42.0000, "estimated_amount": 43, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 97.2, "standard_charge_percentage": 90.0000, "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 44.91, "standard_charge_percentage": 42.0000, "estimated_amount": 44, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 44, "standard_charge_percentage": 42.0000, "estimated_amount": 44, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 44, "standard_charge_percentage": 42.0000, "estimated_amount": 44, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 91.8, "standard_charge_percentage": 85.0000, "estimated_amount": 91, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 97.2, "standard_charge_percentage": 90.0000, "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 75.6, "standard_charge_percentage": 70.0000, "estimated_amount": 75, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 44, "standard_charge_percentage": 42.0000, "estimated_amount": 44, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 108, "estimated_amount": 108, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 86.4, "standard_charge_percentage": 80.0000, "estimated_amount": 86, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 43.09, "standard_charge_percentage": 42.0000, "estimated_amount": 43, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Destruc Benign/Premal,15+ Lesions", "code_information": [ { "code": "17004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1127.75, "discounted_cash": 566,"minimum": 112.04,"maximum": 1127.75,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1127.75, "estimated_amount": 1127, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1014.98, "standard_charge_percentage": 90.0000, "estimated_amount": 1014, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1014.98, "standard_charge_percentage": 90.0000, "estimated_amount": 1014, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 256.45, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 464.64, "estimated_amount": 464, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 986.78, "standard_charge_percentage": 87.5000, "estimated_amount": 986, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 387.49, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 459.45, "standard_charge_percentage": 42.0000, "estimated_amount": 459, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 789.42, "standard_charge_percentage": 70.0000, "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 845.81, "standard_charge_percentage": 75.0000, "estimated_amount": 845, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 468.92, "standard_charge_percentage": 42.0000, "estimated_amount": 468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 789.42, "standard_charge_percentage": 70.0000, "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 459.45, "standard_charge_percentage": 42.0000, "estimated_amount": 459, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 473.65, "standard_charge_percentage": 42.0000, "estimated_amount": 473, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 449.97, "standard_charge_percentage": 42.0000, "estimated_amount": 449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1127.75, "estimated_amount": 1127, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 449.97, "standard_charge_percentage": 42.0000, "estimated_amount": 449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 676.65, "standard_charge_percentage": 60.0000, "estimated_amount": 676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 610.22, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 473.65, "standard_charge_percentage": 42.0000, "estimated_amount": 473, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 789.42, "standard_charge_percentage": 70.0000, "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 427.49, "estimated_amount": 427, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 563.88, "standard_charge_percentage": 50.0000, "estimated_amount": 563, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 459.45, "standard_charge_percentage": 42.0000, "estimated_amount": 459, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 459.45, "standard_charge_percentage": 42.0000, "estimated_amount": 459, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 338.32, "standard_charge_percentage": 30.0000, "estimated_amount": 338, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 444.59, "estimated_amount": 444, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 550.68, "standard_charge_percentage": 48.8300, "estimated_amount": 550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 958.59, "standard_charge_percentage": 85.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 253.8, "estimated_amount": 253, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 256.45, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 902.2, "standard_charge_percentage": 80.0000, "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1071.36, "standard_charge_percentage": 95.0000, "estimated_amount": 1071, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1014.98, "standard_charge_percentage": 90.0000, "estimated_amount": 1014, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 457.66, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 435.87, "estimated_amount": 435, "methodology": "fee schedule" }]}]} , { "description": "Destruct b9 lesion 1-14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 281,"minimum": 59.05,"maximum": 6234.38,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 131.89, "estimated_amount": 131, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 59.05, "estimated_amount": 59, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 77.81, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Chem Cautery Granulatn Tissue", "code_information": [ { "code": "17250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 466, "discounted_cash": 281,"minimum": 130.56,"maximum": 466,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 185.93, "standard_charge_percentage": 42.0000, "estimated_amount": 185, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 192.71, "estimated_amount": 192, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 372.8, "standard_charge_percentage": 80.0000, "estimated_amount": 372, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 419.4, "standard_charge_percentage": 90.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 189.85, "standard_charge_percentage": 42.0000, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 419.4, "standard_charge_percentage": 90.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 396.1, "standard_charge_percentage": 85.0000, "estimated_amount": 396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 326.2, "standard_charge_percentage": 70.0000, "estimated_amount": 326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 130.56, "estimated_amount": 130, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 372.8, "standard_charge_percentage": 80.0000, "estimated_amount": 372, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 372.8, "standard_charge_percentage": 80.0000, "estimated_amount": 372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 195.72, "standard_charge_percentage": 42.0000, "estimated_amount": 195, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 223.33, "estimated_amount": 223, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 372.8, "standard_charge_percentage": 80.0000, "estimated_amount": 372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 349.5, "standard_charge_percentage": 75.0000, "estimated_amount": 349, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 227.55, "standard_charge_percentage": 48.8300, "estimated_amount": 227, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 247.85, "estimated_amount": 247, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 189.85, "standard_charge_percentage": 42.0000, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 372.8, "standard_charge_percentage": 80.0000, "estimated_amount": 372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 466, "estimated_amount": 466, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 132.59, "estimated_amount": 132, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 142.57, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 326.2, "standard_charge_percentage": 70.0000, "estimated_amount": 326, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 193.76, "standard_charge_percentage": 42.0000, "estimated_amount": 193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 372.8, "standard_charge_percentage": 80.0000, "estimated_amount": 372, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 326.2, "standard_charge_percentage": 70.0000, "estimated_amount": 326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 231.08, "estimated_amount": 231, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 189.85, "standard_charge_percentage": 42.0000, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 195.72, "standard_charge_percentage": 42.0000, "estimated_amount": 195, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 419.4, "standard_charge_percentage": 90.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 142.57, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 372.8, "standard_charge_percentage": 80.0000, "estimated_amount": 372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 221.11, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 372.8, "standard_charge_percentage": 80.0000, "estimated_amount": 372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 279.6, "standard_charge_percentage": 60.0000, "estimated_amount": 279, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 372.8, "standard_charge_percentage": 80.0000, "estimated_amount": 372, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 466, "estimated_amount": 466, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 233, "standard_charge_percentage": 50.0000, "estimated_amount": 233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 185.93, "standard_charge_percentage": 42.0000, "estimated_amount": 185, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 227.61, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 372.8, "standard_charge_percentage": 80.0000, "estimated_amount": 372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 303.48, "estimated_amount": 303, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 216.77, "estimated_amount": 216, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 189.85, "standard_charge_percentage": 42.0000, "estimated_amount": 189, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 407.75, "standard_charge_percentage": 87.5000, "estimated_amount": 407, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 139.8, "standard_charge_percentage": 30.0000, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 442.7, "standard_charge_percentage": 95.0000, "estimated_amount": 442, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc I&D Breast Lesion", "code_information": [ { "code": "19000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2403.2, "discounted_cash": 997,"minimum": 256.43,"maximum": 2403.2,"payers_information":[{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1441.92, "standard_charge_percentage": 60.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.34, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1201.6, "standard_charge_percentage": 50.0000, "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.34, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 999.25, "standard_charge_percentage": 42.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2283.04, "standard_charge_percentage": 95.0000, "estimated_amount": 2283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 720.96, "standard_charge_percentage": 30.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2102.8, "standard_charge_percentage": 87.5000, "estimated_amount": 2102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1802.4, "standard_charge_percentage": 75.0000, "estimated_amount": 1802, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2403.2, "estimated_amount": 2403, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2042.72, "standard_charge_percentage": 85.0000, "estimated_amount": 2042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1173.48, "standard_charge_percentage": 48.8300, "estimated_amount": 1173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" }]}]} , { "description": "Hc I&D Breast Lesion Add On", "code_information": [ { "code": "19001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335,"minimum": 100.5,"maximum": 335,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 335, "estimated_amount": 335, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 335, "estimated_amount": 335, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 133.66, "standard_charge_percentage": 42.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 134.6, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 139.29, "standard_charge_percentage": 42.0000, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 293.13, "standard_charge_percentage": 87.5000, "estimated_amount": 293, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 268, "standard_charge_percentage": 80.0000, "estimated_amount": 268, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 268, "standard_charge_percentage": 80.0000, "estimated_amount": 268, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 301.5, "standard_charge_percentage": 90.0000, "estimated_amount": 301, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 234.5, "standard_charge_percentage": 70.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 140.7, "standard_charge_percentage": 42.0000, "estimated_amount": 140, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 167.5, "standard_charge_percentage": 50.0000, "estimated_amount": 167, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 268, "standard_charge_percentage": 80.0000, "estimated_amount": 268, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 201, "standard_charge_percentage": 60.0000, "estimated_amount": 201, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 268, "standard_charge_percentage": 80.0000, "estimated_amount": 268, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 133.66, "standard_charge_percentage": 42.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 100.5, "standard_charge_percentage": 30.0000, "estimated_amount": 100, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 134.6, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 268, "standard_charge_percentage": 80.0000, "estimated_amount": 268, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 268, "standard_charge_percentage": 80.0000, "estimated_amount": 268, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 268, "standard_charge_percentage": 80.0000, "estimated_amount": 268, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 268, "standard_charge_percentage": 80.0000, "estimated_amount": 268, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 268, "standard_charge_percentage": 80.0000, "estimated_amount": 268, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 136.48, "standard_charge_percentage": 42.0000, "estimated_amount": 136, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 136.48, "standard_charge_percentage": 42.0000, "estimated_amount": 136, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 268, "standard_charge_percentage": 80.0000, "estimated_amount": 268, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 136.48, "standard_charge_percentage": 42.0000, "estimated_amount": 136, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 318.25, "standard_charge_percentage": 95.0000, "estimated_amount": 318, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 284.75, "standard_charge_percentage": 85.0000, "estimated_amount": 284, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 136.48, "standard_charge_percentage": 42.0000, "estimated_amount": 136, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 140.7, "standard_charge_percentage": 42.0000, "estimated_amount": 140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 234.5, "standard_charge_percentage": 70.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 301.5, "standard_charge_percentage": 90.0000, "estimated_amount": 301, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 234.5, "standard_charge_percentage": 70.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 301.5, "standard_charge_percentage": 90.0000, "estimated_amount": 301, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 251.25, "standard_charge_percentage": 75.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" }]}]} , { "description": "Mastotomy expl drg absc dp", "code_information": [ { "code": "19020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1414.28, "discounted_cash": 2297,"minimum": 424.28,"maximum": 1414.28,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1202.14, "standard_charge_percentage": 85.0000, "estimated_amount": 1202, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1131.42, "standard_charge_percentage": 80.0000, "estimated_amount": 1131, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 594, "standard_charge_percentage": 42.0000, "estimated_amount": 594, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1131.42, "standard_charge_percentage": 80.0000, "estimated_amount": 1131, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1131.42, "standard_charge_percentage": 80.0000, "estimated_amount": 1131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1131.42, "standard_charge_percentage": 80.0000, "estimated_amount": 1131, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 576.18, "standard_charge_percentage": 42.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1131.42, "standard_charge_percentage": 80.0000, "estimated_amount": 1131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 990, "standard_charge_percentage": 70.0000, "estimated_amount": 990, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1131.42, "standard_charge_percentage": 80.0000, "estimated_amount": 1131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 424.28, "standard_charge_percentage": 30.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 594, "standard_charge_percentage": 42.0000, "estimated_amount": 594, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1060.71, "standard_charge_percentage": 75.0000, "estimated_amount": 1060, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 990, "standard_charge_percentage": 70.0000, "estimated_amount": 990, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1131.42, "standard_charge_percentage": 80.0000, "estimated_amount": 1131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 848.57, "standard_charge_percentage": 60.0000, "estimated_amount": 848, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1131.42, "standard_charge_percentage": 80.0000, "estimated_amount": 1131, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1272.85, "standard_charge_percentage": 90.0000, "estimated_amount": 1272, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 588.06, "standard_charge_percentage": 42.0000, "estimated_amount": 588, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1343.57, "standard_charge_percentage": 95.0000, "estimated_amount": 1343, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1272.85, "standard_charge_percentage": 90.0000, "estimated_amount": 1272, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 564.3, "standard_charge_percentage": 42.0000, "estimated_amount": 564, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 576.18, "standard_charge_percentage": 42.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 564.3, "standard_charge_percentage": 42.0000, "estimated_amount": 564, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 576.18, "standard_charge_percentage": 42.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 690.59, "standard_charge_percentage": 48.8300, "estimated_amount": 690, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1237.49, "standard_charge_percentage": 87.5000, "estimated_amount": 1237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1272.85, "standard_charge_percentage": 90.0000, "estimated_amount": 1272, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1131.42, "standard_charge_percentage": 80.0000, "estimated_amount": 1131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 990, "standard_charge_percentage": 70.0000, "estimated_amount": 990, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 576.18, "standard_charge_percentage": 42.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 707.14, "standard_charge_percentage": 50.0000, "estimated_amount": 707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1414.28, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1131.42, "standard_charge_percentage": 80.0000, "estimated_amount": 1131, "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": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 4709.9,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4709.9, "estimated_amount": 4709, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 959.41, "standard_charge_percentage": 21.0000, "estimated_amount": 959, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 939.63, "standard_charge_percentage": 21.0000, "estimated_amount": 939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 979.19, "standard_charge_percentage": 21.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 939.63, "standard_charge_percentage": 21.0000, "estimated_amount": 939, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 959.41, "standard_charge_percentage": 21.0000, "estimated_amount": 959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 989.08, "standard_charge_percentage": 21.0000, "estimated_amount": 989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 907.9, "estimated_amount": 907, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 989.08, "standard_charge_percentage": 21.0000, "estimated_amount": 989, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 959.41, "standard_charge_percentage": 21.0000, "estimated_amount": 959, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 959.41, "standard_charge_percentage": 21.0000, "estimated_amount": 959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 907.9, "estimated_amount": 907, "methodology": "case rate" }]}]} , { "description": "Hc Bx Breast W Device Stereotact Guide Addl Lesion", "code_information": [ { "code": "19082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5263.15,"minimum": 282,"maximum": 4999.99,"payers_information":[{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3684.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3684, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1072.1, "standard_charge_percentage": 21.0000, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1072.1, "standard_charge_percentage": 21.0000, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1050, "standard_charge_percentage": 21.0000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1072.1, "standard_charge_percentage": 21.0000, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1578.94, "standard_charge_percentage": 30.0000, "estimated_amount": 1578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3947.36, "standard_charge_percentage": 75.0000, "estimated_amount": 3947, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1105.26, "standard_charge_percentage": 21.0000, "estimated_amount": 1105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3684.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1105.26, "standard_charge_percentage": 21.0000, "estimated_amount": 1105, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4999.99, "standard_charge_percentage": 95.0000, "estimated_amount": 4999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4736.83, "standard_charge_percentage": 90.0000, "estimated_amount": 4736, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1050, "standard_charge_percentage": 21.0000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1072.1, "standard_charge_percentage": 21.0000, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2631.57, "standard_charge_percentage": 50.0000, "estimated_amount": 2631, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1094.21, "standard_charge_percentage": 21.0000, "estimated_amount": 1094, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4473.68, "standard_charge_percentage": 85.0000, "estimated_amount": 4473, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4736.83, "standard_charge_percentage": 90.0000, "estimated_amount": 4736, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3684.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3684, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4605.26, "standard_charge_percentage": 87.5000, "estimated_amount": 4605, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3157.89, "standard_charge_percentage": 60.0000, "estimated_amount": 3157, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4736.83, "standard_charge_percentage": 90.0000, "estimated_amount": 4736, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Bx Breast W Device Us Guide 1St Lesion", "code_information": [ { "code": "19083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9419.8, "discounted_cash": 2297,"minimum": 519.96,"maximum": 8948.81,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 7064.85, "standard_charge_percentage": 75.0000, "estimated_amount": 7064, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3837.63, "standard_charge_percentage": 42.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 8477.82, "standard_charge_percentage": 90.0000, "estimated_amount": 8477, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3758.5, "standard_charge_percentage": 42.0000, "estimated_amount": 3758, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6593.86, "standard_charge_percentage": 70.0000, "estimated_amount": 6593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7535.84, "standard_charge_percentage": 80.0000, "estimated_amount": 7535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 7535.84, "standard_charge_percentage": 80.0000, "estimated_amount": 7535, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 8006.83, "standard_charge_percentage": 85.0000, "estimated_amount": 8006, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 8477.82, "standard_charge_percentage": 90.0000, "estimated_amount": 8477, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6593.86, "standard_charge_percentage": 70.0000, "estimated_amount": 6593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7535.84, "standard_charge_percentage": 80.0000, "estimated_amount": 7535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6593.86, "standard_charge_percentage": 70.0000, "estimated_amount": 6593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 8242.32, "standard_charge_percentage": 87.5000, "estimated_amount": 8242, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4709.9, "standard_charge_percentage": 50.0000, "estimated_amount": 4709, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 7535.84, "standard_charge_percentage": 80.0000, "estimated_amount": 7535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5651.88, "standard_charge_percentage": 60.0000, "estimated_amount": 5651, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 30.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 7535.84, "standard_charge_percentage": 80.0000, "estimated_amount": 7535, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 7535.84, "standard_charge_percentage": 80.0000, "estimated_amount": 7535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3837.63, "standard_charge_percentage": 42.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 4599.69, "standard_charge_percentage": 48.8300, "estimated_amount": 4599, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3837.63, "standard_charge_percentage": 42.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 7535.84, "standard_charge_percentage": 80.0000, "estimated_amount": 7535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3758.5, "standard_charge_percentage": 42.0000, "estimated_amount": 3758, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 8477.82, "standard_charge_percentage": 90.0000, "estimated_amount": 8477, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3837.63, "standard_charge_percentage": 42.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 7535.84, "standard_charge_percentage": 80.0000, "estimated_amount": 7535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3916.75, "standard_charge_percentage": 42.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 8948.81, "standard_charge_percentage": 95.0000, "estimated_amount": 8948, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 907.9, "estimated_amount": 907, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 907.9, "estimated_amount": 907, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3956.32, "standard_charge_percentage": 42.0000, "estimated_amount": 3956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 7535.84, "standard_charge_percentage": 80.0000, "estimated_amount": 7535, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 7535.84, "standard_charge_percentage": 80.0000, "estimated_amount": 7535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3956.32, "standard_charge_percentage": 42.0000, "estimated_amount": 3956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" }]}]} , { "description": "US TESTICLE SONO", "code_information": [ { "code": "19084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5263.15,"minimum": 282,"maximum": 4999.99,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4736.83, "standard_charge_percentage": 90.0000, "estimated_amount": 4736, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1578.94, "standard_charge_percentage": 30.0000, "estimated_amount": 1578, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4736.83, "standard_charge_percentage": 90.0000, "estimated_amount": 4736, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1072.1, "standard_charge_percentage": 21.0000, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4736.83, "standard_charge_percentage": 90.0000, "estimated_amount": 4736, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1072.1, "standard_charge_percentage": 21.0000, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3947.36, "standard_charge_percentage": 75.0000, "estimated_amount": 3947, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3157.89, "standard_charge_percentage": 60.0000, "estimated_amount": 3157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3684.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3684, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4999.99, "standard_charge_percentage": 95.0000, "estimated_amount": 4999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1050, "standard_charge_percentage": 21.0000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3684.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1105.26, "standard_charge_percentage": 21.0000, "estimated_amount": 1105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3684.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3684, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4605.26, "standard_charge_percentage": 87.5000, "estimated_amount": 4605, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1050, "standard_charge_percentage": 21.0000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1072.1, "standard_charge_percentage": 21.0000, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1094.21, "standard_charge_percentage": 21.0000, "estimated_amount": 1094, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1072.1, "standard_charge_percentage": 21.0000, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2631.57, "standard_charge_percentage": 50.0000, "estimated_amount": 2631, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1105.26, "standard_charge_percentage": 21.0000, "estimated_amount": 1105, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4473.68, "standard_charge_percentage": 85.0000, "estimated_amount": 4473, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Bx Breast W Device Mri Guide 1St Lesion", "code_information": [ { "code": "19085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 2297,"minimum": 519.96,"maximum": 6717.83,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 907.9, "estimated_amount": 907, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1484.99, "standard_charge_percentage": 21.0000, "estimated_amount": 1484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1440.44, "standard_charge_percentage": 21.0000, "estimated_amount": 1440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1410.74, "standard_charge_percentage": 21.0000, "estimated_amount": 1410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1410.74, "standard_charge_percentage": 21.0000, "estimated_amount": 1410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1484.99, "standard_charge_percentage": 21.0000, "estimated_amount": 1484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1440.44, "standard_charge_percentage": 21.0000, "estimated_amount": 1440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1440.44, "standard_charge_percentage": 21.0000, "estimated_amount": 1440, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1470.14, "standard_charge_percentage": 21.0000, "estimated_amount": 1470, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1440.44, "standard_charge_percentage": 21.0000, "estimated_amount": 1440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 907.9, "estimated_amount": 907, "methodology": "case rate" }]}]} , { "description": "Hc Bx Breast W Device Mri Guide Addl Lesion", "code_information": [ { "code": "19086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5263.15,"minimum": 282,"maximum": 4999.99,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1578.94, "standard_charge_percentage": 30.0000, "estimated_amount": 1578, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1072.1, "standard_charge_percentage": 21.0000, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1072.1, "standard_charge_percentage": 21.0000, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1050, "standard_charge_percentage": 21.0000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4736.83, "standard_charge_percentage": 90.0000, "estimated_amount": 4736, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1050, "standard_charge_percentage": 21.0000, "estimated_amount": 1050, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3684.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3684, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4605.26, "standard_charge_percentage": 87.5000, "estimated_amount": 4605, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1105.26, "standard_charge_percentage": 21.0000, "estimated_amount": 1105, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1094.21, "standard_charge_percentage": 21.0000, "estimated_amount": 1094, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3684.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4999.99, "standard_charge_percentage": 95.0000, "estimated_amount": 4999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3684.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3684, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4473.68, "standard_charge_percentage": 85.0000, "estimated_amount": 4473, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1072.1, "standard_charge_percentage": 21.0000, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1072.1, "standard_charge_percentage": 21.0000, "estimated_amount": 1072, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2631.57, "standard_charge_percentage": 50.0000, "estimated_amount": 2631, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3157.89, "standard_charge_percentage": 60.0000, "estimated_amount": 3157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4736.83, "standard_charge_percentage": 90.0000, "estimated_amount": 4736, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1105.26, "standard_charge_percentage": 21.0000, "estimated_amount": 1105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3947.36, "standard_charge_percentage": 75.0000, "estimated_amount": 3947, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4736.83, "standard_charge_percentage": 90.0000, "estimated_amount": 4736, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4210.52, "standard_charge_percentage": 80.0000, "estimated_amount": 4210, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Bx Breast, Needle Core", "code_information": [ { "code": "19100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 256.43,"maximum": 4709.9,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4709.9, "estimated_amount": 4709, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.34, "estimated_amount": 420, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.34, "estimated_amount": 420, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" }]}]} , { "description": "Removal of breast lesion", "code_information": [ { "code": "19120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7914.01, "discounted_cash": 5430,"minimum": 1216,"maximum": 7518.31,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 4453.31, "estimated_amount": 4453, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3957.01, "standard_charge_percentage": 50.0000, "estimated_amount": 3957, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5935.51, "standard_charge_percentage": 75.0000, "estimated_amount": 5935, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 4261.14, "estimated_amount": 4261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7122.61, "standard_charge_percentage": 90.0000, "estimated_amount": 7122, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2019.12, "estimated_amount": 2019, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3864.41, "standard_charge_percentage": 48.8300, "estimated_amount": 3864, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3290.65, "standard_charge_percentage": 42.0000, "estimated_amount": 3290, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6331.21, "standard_charge_percentage": 80.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6331.21, "standard_charge_percentage": 80.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3224.17, "standard_charge_percentage": 42.0000, "estimated_amount": 3224, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6331.21, "standard_charge_percentage": 80.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6331.21, "standard_charge_percentage": 80.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7518.31, "standard_charge_percentage": 95.0000, "estimated_amount": 7518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3323.88, "standard_charge_percentage": 42.0000, "estimated_amount": 3323, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3224.17, "standard_charge_percentage": 42.0000, "estimated_amount": 3224, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4146.83, "estimated_amount": 4146, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4261.14, "estimated_amount": 4261, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7122.61, "standard_charge_percentage": 90.0000, "estimated_amount": 7122, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6726.91, "standard_charge_percentage": 85.0000, "estimated_amount": 6726, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6924.76, "standard_charge_percentage": 87.5000, "estimated_amount": 6924, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2019.12, "estimated_amount": 2019, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5539.81, "standard_charge_percentage": 70.0000, "estimated_amount": 5539, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7122.61, "standard_charge_percentage": 90.0000, "estimated_amount": 7122, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4748.41, "standard_charge_percentage": 60.0000, "estimated_amount": 4748, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3224.17, "standard_charge_percentage": 42.0000, "estimated_amount": 3224, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6331.21, "standard_charge_percentage": 80.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3157.69, "standard_charge_percentage": 42.0000, "estimated_amount": 3157, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3224.17, "standard_charge_percentage": 42.0000, "estimated_amount": 3224, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6331.21, "standard_charge_percentage": 80.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6331.21, "standard_charge_percentage": 80.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3157.69, "standard_charge_percentage": 42.0000, "estimated_amount": 3157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 4386.47, "estimated_amount": 4386, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6331.21, "standard_charge_percentage": 80.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3323.88, "standard_charge_percentage": 42.0000, "estimated_amount": 3323, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5539.81, "standard_charge_percentage": 70.0000, "estimated_amount": 5539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5539.81, "standard_charge_percentage": 70.0000, "estimated_amount": 5539, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2461.93, "estimated_amount": 2461, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6331.21, "standard_charge_percentage": 80.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6331.21, "standard_charge_percentage": 80.0000, "estimated_amount": 6331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5848.63, "estimated_amount": 5848, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3713.88, "estimated_amount": 3713, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2374.2, "standard_charge_percentage": 30.0000, "estimated_amount": 2374, "methodology": "percent of total billed charges" }]}]} , { "description": "Excision breast lesion", "code_information": [ { "code": "19125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9873.57, "discounted_cash": 5430,"minimum": 1045.33,"maximum": 9379.89,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 4821.26, "standard_charge_percentage": 48.8300, "estimated_amount": 4821, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4022.49, "standard_charge_percentage": 42.0000, "estimated_amount": 4022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5848.63, "estimated_amount": 5848, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3939.55, "standard_charge_percentage": 42.0000, "estimated_amount": 3939, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4146.83, "estimated_amount": 4146, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4261.14, "estimated_amount": 4261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 8886.21, "standard_charge_percentage": 90.0000, "estimated_amount": 8886, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2461.93, "estimated_amount": 2461, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4146.9, "standard_charge_percentage": 42.0000, "estimated_amount": 4146, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6911.5, "standard_charge_percentage": 70.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4936.78, "standard_charge_percentage": 50.0000, "estimated_amount": 4936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 8886.21, "standard_charge_percentage": 90.0000, "estimated_amount": 8886, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 9379.89, "standard_charge_percentage": 95.0000, "estimated_amount": 9379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2019.12, "estimated_amount": 2019, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3939.55, "standard_charge_percentage": 42.0000, "estimated_amount": 3939, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6911.5, "standard_charge_percentage": 70.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4022.49, "standard_charge_percentage": 42.0000, "estimated_amount": 4022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4146.9, "standard_charge_percentage": 42.0000, "estimated_amount": 4146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2019.12, "estimated_amount": 2019, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4105.43, "standard_charge_percentage": 42.0000, "estimated_amount": 4105, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 8886.21, "standard_charge_percentage": 90.0000, "estimated_amount": 8886, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2962.07, "standard_charge_percentage": 30.0000, "estimated_amount": 2962, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 4453.31, "estimated_amount": 4453, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 7405.18, "standard_charge_percentage": 75.0000, "estimated_amount": 7405, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5924.14, "standard_charge_percentage": 60.0000, "estimated_amount": 5924, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4022.49, "standard_charge_percentage": 42.0000, "estimated_amount": 4022, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 8639.37, "standard_charge_percentage": 87.5000, "estimated_amount": 8639, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 4386.47, "estimated_amount": 4386, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6911.5, "standard_charge_percentage": 70.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 4261.14, "estimated_amount": 4261, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 8392.53, "standard_charge_percentage": 85.0000, "estimated_amount": 8392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3713.88, "estimated_amount": 3713, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4022.49, "standard_charge_percentage": 42.0000, "estimated_amount": 4022, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" }]}]} , { "description": "Perq device breast 1st imag", "code_information": [ { "code": "19281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4806.4, "discounted_cash": 2297,"minimum": 112.04,"maximum": 4806.4,"payers_information":[{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 21.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2403.2, "standard_charge_percentage": 50.0000, "estimated_amount": 2403, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 21.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 21.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4085.44, "standard_charge_percentage": 85.0000, "estimated_amount": 4085, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 21.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 21.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3364.48, "standard_charge_percentage": 70.0000, "estimated_amount": 3364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3364.48, "standard_charge_percentage": 70.0000, "estimated_amount": 3364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1441.92, "standard_charge_percentage": 30.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4566.08, "standard_charge_percentage": 95.0000, "estimated_amount": 4566, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4205.6, "standard_charge_percentage": 87.5000, "estimated_amount": 4205, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 999.25, "standard_charge_percentage": 21.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 21.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2883.84, "standard_charge_percentage": 60.0000, "estimated_amount": 2883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2346.97, "standard_charge_percentage": 48.8300, "estimated_amount": 2346, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 21.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4325.76, "standard_charge_percentage": 90.0000, "estimated_amount": 4325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3604.8, "standard_charge_percentage": 75.0000, "estimated_amount": 3604, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4325.76, "standard_charge_percentage": 90.0000, "estimated_amount": 4325, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4806.4, "estimated_amount": 4806, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3364.48, "standard_charge_percentage": 70.0000, "estimated_amount": 3364, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 21.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4325.76, "standard_charge_percentage": 90.0000, "estimated_amount": 4325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 127.07, "estimated_amount": 127, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 127.07, "estimated_amount": 127, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" }]}]} , { "description": "Hc Perq Device Placemt Breast Loc Ea Les W Guidnce", "code_information": [ { "code": "19282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.28,"minimum": 141.1,"maximum": 707.28,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 530.46, "standard_charge_percentage": 75.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 495.1, "standard_charge_percentage": 70.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 636.55, "standard_charge_percentage": 90.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 636.55, "standard_charge_percentage": 90.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 212.18, "standard_charge_percentage": 30.0000, "estimated_amount": 212, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 636.55, "standard_charge_percentage": 90.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 707.28, "estimated_amount": 707, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 353.64, "standard_charge_percentage": 50.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 618.87, "standard_charge_percentage": 87.5000, "estimated_amount": 618, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 148.53, "standard_charge_percentage": 21.0000, "estimated_amount": 148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 141.1, "standard_charge_percentage": 21.0000, "estimated_amount": 141, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 495.1, "standard_charge_percentage": 70.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 141.1, "standard_charge_percentage": 21.0000, "estimated_amount": 141, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 424.37, "standard_charge_percentage": 60.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 147.04, "standard_charge_percentage": 21.0000, "estimated_amount": 147, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 495.1, "standard_charge_percentage": 70.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 148.53, "standard_charge_percentage": 21.0000, "estimated_amount": 148, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 601.19, "standard_charge_percentage": 85.0000, "estimated_amount": 601, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 671.92, "standard_charge_percentage": 95.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 707.28, "estimated_amount": 707, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" }]}]} , { "description": "Perq dev breast 1st strtctc", "code_information": [ { "code": "19283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4806.4, "discounted_cash": 997,"minimum": 112.04,"maximum": 4566.08,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2883.84, "standard_charge_percentage": 60.0000, "estimated_amount": 2883, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4325.76, "standard_charge_percentage": 90.0000, "estimated_amount": 4325, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2346.97, "standard_charge_percentage": 48.8300, "estimated_amount": 2346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1441.92, "standard_charge_percentage": 30.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 127.07, "estimated_amount": 127, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4085.44, "standard_charge_percentage": 85.0000, "estimated_amount": 4085, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4566.08, "standard_charge_percentage": 95.0000, "estimated_amount": 4566, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 999.25, "standard_charge_percentage": 21.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4205.6, "standard_charge_percentage": 87.5000, "estimated_amount": 4205, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4325.76, "standard_charge_percentage": 90.0000, "estimated_amount": 4325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 21.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3604.8, "standard_charge_percentage": 75.0000, "estimated_amount": 3604, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 127.07, "estimated_amount": 127, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 21.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3364.48, "standard_charge_percentage": 70.0000, "estimated_amount": 3364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 21.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4325.76, "standard_charge_percentage": 90.0000, "estimated_amount": 4325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3364.48, "standard_charge_percentage": 70.0000, "estimated_amount": 3364, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 21.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2403.2, "standard_charge_percentage": 50.0000, "estimated_amount": 2403, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3364.48, "standard_charge_percentage": 70.0000, "estimated_amount": 3364, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 21.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 21.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 21.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 21.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3845.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3845, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Perq Breast Loc Dev Place Strotact Guid Add Les", "code_information": [ { "code": "19284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.28,"minimum": 141.1,"maximum": 707.28,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 148.53, "standard_charge_percentage": 21.0000, "estimated_amount": 148, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 671.92, "standard_charge_percentage": 95.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 147.04, "standard_charge_percentage": 21.0000, "estimated_amount": 147, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 601.19, "standard_charge_percentage": 85.0000, "estimated_amount": 601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 707.28, "estimated_amount": 707, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 495.1, "standard_charge_percentage": 70.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 530.46, "standard_charge_percentage": 75.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 141.1, "standard_charge_percentage": 21.0000, "estimated_amount": 141, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 636.55, "standard_charge_percentage": 90.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 141.1, "standard_charge_percentage": 21.0000, "estimated_amount": 141, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 424.37, "standard_charge_percentage": 60.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 636.55, "standard_charge_percentage": 90.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 148.53, "standard_charge_percentage": 21.0000, "estimated_amount": 148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 495.1, "standard_charge_percentage": 70.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 495.1, "standard_charge_percentage": 70.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 636.55, "standard_charge_percentage": 90.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 353.64, "standard_charge_percentage": 50.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 618.87, "standard_charge_percentage": 87.5000, "estimated_amount": 618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 212.18, "standard_charge_percentage": 30.0000, "estimated_amount": 212, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 707.28, "estimated_amount": 707, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" }]}]} , { "description": "US XTR NON VAS COMPLETE", "code_information": [ { "code": "19285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2403.2, "discounted_cash": 997,"minimum": 112.04,"maximum": 2403.2,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1173.48, "standard_charge_percentage": 48.8300, "estimated_amount": 1173, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.53, "standard_charge_percentage": 21.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2403.2, "estimated_amount": 2403, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 127.07, "estimated_amount": 127, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2283.04, "standard_charge_percentage": 95.0000, "estimated_amount": 2283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.44, "standard_charge_percentage": 21.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2042.72, "standard_charge_percentage": 85.0000, "estimated_amount": 2042, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.63, "standard_charge_percentage": 21.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1201.6, "standard_charge_percentage": 50.0000, "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.67, "standard_charge_percentage": 21.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.44, "standard_charge_percentage": 21.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1441.92, "standard_charge_percentage": 60.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.67, "standard_charge_percentage": 21.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 720.96, "standard_charge_percentage": 30.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2102.8, "standard_charge_percentage": 87.5000, "estimated_amount": 2102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1802.4, "standard_charge_percentage": 75.0000, "estimated_amount": 1802, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.53, "standard_charge_percentage": 21.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 127.07, "estimated_amount": 127, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.53, "standard_charge_percentage": 21.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.53, "standard_charge_percentage": 21.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" }]}]} , { "description": "US XTR NON VASC LMTD", "code_information": [ { "code": "19286", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.28,"minimum": 141.1,"maximum": 707.28,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 636.55, "standard_charge_percentage": 90.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 495.1, "standard_charge_percentage": 70.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 601.19, "standard_charge_percentage": 85.0000, "estimated_amount": 601, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 707.28, "estimated_amount": 707, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 636.55, "standard_charge_percentage": 90.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 618.87, "standard_charge_percentage": 87.5000, "estimated_amount": 618, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 141.1, "standard_charge_percentage": 21.0000, "estimated_amount": 141, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 495.1, "standard_charge_percentage": 70.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 141.1, "standard_charge_percentage": 21.0000, "estimated_amount": 141, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 147.04, "standard_charge_percentage": 21.0000, "estimated_amount": 147, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 212.18, "standard_charge_percentage": 30.0000, "estimated_amount": 212, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 353.64, "standard_charge_percentage": 50.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 636.55, "standard_charge_percentage": 90.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 530.46, "standard_charge_percentage": 75.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 148.53, "standard_charge_percentage": 21.0000, "estimated_amount": 148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 707.28, "estimated_amount": 707, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 671.92, "standard_charge_percentage": 95.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 148.53, "standard_charge_percentage": 21.0000, "estimated_amount": 148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 495.1, "standard_charge_percentage": 70.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 424.37, "standard_charge_percentage": 60.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Perq Breast Loc Dev Place Mri Guide 1St Lesion", "code_information": [ { "code": "19287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2403.2, "discounted_cash": 997,"minimum": 112.04,"maximum": 2403.2,"payers_information":[{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 127.07, "estimated_amount": 127, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 489.53, "standard_charge_percentage": 21.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2102.8, "standard_charge_percentage": 87.5000, "estimated_amount": 2102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2283.04, "standard_charge_percentage": 95.0000, "estimated_amount": 2283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2042.72, "standard_charge_percentage": 85.0000, "estimated_amount": 2042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 479.44, "standard_charge_percentage": 21.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 479.44, "standard_charge_percentage": 21.0000, "estimated_amount": 479, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1802.4, "standard_charge_percentage": 75.0000, "estimated_amount": 1802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1441.92, "standard_charge_percentage": 60.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 720.96, "standard_charge_percentage": 30.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 499.63, "standard_charge_percentage": 21.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1173.48, "standard_charge_percentage": 48.8300, "estimated_amount": 1173, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 504.67, "standard_charge_percentage": 21.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1201.6, "standard_charge_percentage": 50.0000, "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 489.53, "standard_charge_percentage": 21.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 127.07, "estimated_amount": 127, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 489.53, "standard_charge_percentage": 21.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2403.2, "estimated_amount": 2403, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 489.53, "standard_charge_percentage": 21.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 504.67, "standard_charge_percentage": 21.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" }]}]} , { "description": "Hc Perq Breast Loc Dev Place Mri Guide Addl Lesion", "code_information": [ { "code": "19288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.28,"minimum": 141.1,"maximum": 707.28,"payers_information":[{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 147.04, "standard_charge_percentage": 21.0000, "estimated_amount": 147, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 141.1, "standard_charge_percentage": 21.0000, "estimated_amount": 141, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 353.64, "standard_charge_percentage": 50.0000, "estimated_amount": 353, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 636.55, "standard_charge_percentage": 90.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 636.55, "standard_charge_percentage": 90.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 424.37, "standard_charge_percentage": 60.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 495.1, "standard_charge_percentage": 70.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 495.1, "standard_charge_percentage": 70.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 671.92, "standard_charge_percentage": 95.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 636.55, "standard_charge_percentage": 90.0000, "estimated_amount": 636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 530.46, "standard_charge_percentage": 75.0000, "estimated_amount": 530, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 601.19, "standard_charge_percentage": 85.0000, "estimated_amount": 601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 707.28, "estimated_amount": 707, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 141.1, "standard_charge_percentage": 21.0000, "estimated_amount": 141, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 212.18, "standard_charge_percentage": 30.0000, "estimated_amount": 212, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 148.53, "standard_charge_percentage": 21.0000, "estimated_amount": 148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 148.53, "standard_charge_percentage": 21.0000, "estimated_amount": 148, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 618.87, "standard_charge_percentage": 87.5000, "estimated_amount": 618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 495.1, "standard_charge_percentage": 70.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 144.07, "standard_charge_percentage": 21.0000, "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 565.82, "standard_charge_percentage": 80.0000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 707.28, "estimated_amount": 707, "methodology": "case rate" }]}]} , { "description": "Partial mastectomy", "code_information": [ { "code": "19301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9595.26, "discounted_cash": 5430,"minimum": 1216,"maximum": 9115.5,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7676.21, "standard_charge_percentage": 80.0000, "estimated_amount": 7676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 9115.5, "standard_charge_percentage": 95.0000, "estimated_amount": 9115, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 4685.37, "standard_charge_percentage": 48.8300, "estimated_amount": 4685, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6716.68, "standard_charge_percentage": 70.0000, "estimated_amount": 6716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 5848.63, "estimated_amount": 5848, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 8635.73, "standard_charge_percentage": 90.0000, "estimated_amount": 8635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 7676.21, "standard_charge_percentage": 80.0000, "estimated_amount": 7676, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3909.11, "standard_charge_percentage": 42.0000, "estimated_amount": 3909, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3828.51, "standard_charge_percentage": 42.0000, "estimated_amount": 3828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5757.16, "standard_charge_percentage": 60.0000, "estimated_amount": 5757, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 7676.21, "standard_charge_percentage": 80.0000, "estimated_amount": 7676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 4261.14, "estimated_amount": 4261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 7676.21, "standard_charge_percentage": 80.0000, "estimated_amount": 7676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4030.01, "standard_charge_percentage": 42.0000, "estimated_amount": 4030, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 7676.21, "standard_charge_percentage": 80.0000, "estimated_amount": 7676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3909.11, "standard_charge_percentage": 42.0000, "estimated_amount": 3909, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 8635.73, "standard_charge_percentage": 90.0000, "estimated_amount": 8635, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3909.11, "standard_charge_percentage": 42.0000, "estimated_amount": 3909, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 8155.97, "standard_charge_percentage": 85.0000, "estimated_amount": 8155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 4261.14, "estimated_amount": 4261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 4386.47, "estimated_amount": 4386, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3909.11, "standard_charge_percentage": 42.0000, "estimated_amount": 3909, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3713.88, "estimated_amount": 3713, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 4453.31, "estimated_amount": 4453, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2019.12, "estimated_amount": 2019, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6716.68, "standard_charge_percentage": 70.0000, "estimated_amount": 6716, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 7676.21, "standard_charge_percentage": 80.0000, "estimated_amount": 7676, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3989.71, "standard_charge_percentage": 42.0000, "estimated_amount": 3989, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 7676.21, "standard_charge_percentage": 80.0000, "estimated_amount": 7676, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4146.83, "estimated_amount": 4146, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 7676.21, "standard_charge_percentage": 80.0000, "estimated_amount": 7676, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4797.63, "standard_charge_percentage": 50.0000, "estimated_amount": 4797, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 8395.85, "standard_charge_percentage": 87.5000, "estimated_amount": 8395, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6716.68, "standard_charge_percentage": 70.0000, "estimated_amount": 6716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3828.51, "standard_charge_percentage": 42.0000, "estimated_amount": 3828, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2461.93, "estimated_amount": 2461, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7676.21, "standard_charge_percentage": 80.0000, "estimated_amount": 7676, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4030.01, "standard_charge_percentage": 42.0000, "estimated_amount": 4030, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 8635.73, "standard_charge_percentage": 90.0000, "estimated_amount": 8635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 7676.21, "standard_charge_percentage": 80.0000, "estimated_amount": 7676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 7196.44, "standard_charge_percentage": 75.0000, "estimated_amount": 7196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 4177.59, "estimated_amount": 4177, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2878.58, "standard_charge_percentage": 30.0000, "estimated_amount": 2878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2019.12, "estimated_amount": 2019, "methodology": "case rate" }]}]} , { "description": "Mast simple complete", "code_information": [ { "code": "19303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12138.9, "discounted_cash": 9249,"minimum": 1287,"maximum": 11532,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 7114.65, "estimated_amount": 7114, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 10925, "standard_charge_percentage": 90.0000, "estimated_amount": 10925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7256.94, "estimated_amount": 7256, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 5047.35, "standard_charge_percentage": 42.0000, "estimated_amount": 5047, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7114.65, "estimated_amount": 7114, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 10925, "standard_charge_percentage": 90.0000, "estimated_amount": 10925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 6324.92, "estimated_amount": 6324, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7283.34, "standard_charge_percentage": 60.0000, "estimated_amount": 7283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5927.42, "standard_charge_percentage": 48.8300, "estimated_amount": 5927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9960.51, "estimated_amount": 9960, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 9711.12, "standard_charge_percentage": 80.0000, "estimated_amount": 9711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 4500.61, "estimated_amount": 4500, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7114.65, "estimated_amount": 7114, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 9104.17, "standard_charge_percentage": 75.0000, "estimated_amount": 9104, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 10621.5, "standard_charge_percentage": 87.5000, "estimated_amount": 10621, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 4843.42, "standard_charge_percentage": 42.0000, "estimated_amount": 4843, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 10925, "standard_charge_percentage": 90.0000, "estimated_amount": 10925, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1287, "estimated_amount": 1287, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4945.39, "standard_charge_percentage": 42.0000, "estimated_amount": 4945, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5854, "estimated_amount": 5854, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 7114.65, "estimated_amount": 7114, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 6069.45, "standard_charge_percentage": 50.0000, "estimated_amount": 6069, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7114.65, "estimated_amount": 7114, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 5098.34, "standard_charge_percentage": 42.0000, "estimated_amount": 5098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 7114.65, "estimated_amount": 7114, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 5098.34, "standard_charge_percentage": 42.0000, "estimated_amount": 5098, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 9711.12, "standard_charge_percentage": 80.0000, "estimated_amount": 9711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9711.12, "standard_charge_percentage": 80.0000, "estimated_amount": 9711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7114.65, "estimated_amount": 7114, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 3155.25, "estimated_amount": 3155, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 9711.12, "standard_charge_percentage": 80.0000, "estimated_amount": 9711, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 6912.31, "estimated_amount": 6912, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7114.65, "estimated_amount": 7114, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 8497.23, "standard_charge_percentage": 70.0000, "estimated_amount": 8497, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 7114.65, "estimated_amount": 7114, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 7114.65, "estimated_amount": 7114, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 7256.94, "estimated_amount": 7256, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4945.39, "standard_charge_percentage": 42.0000, "estimated_amount": 4945, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4945.39, "standard_charge_percentage": 42.0000, "estimated_amount": 4945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 7584.22, "estimated_amount": 7584, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 10318.1, "standard_charge_percentage": 85.0000, "estimated_amount": 10318, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 11532, "standard_charge_percentage": 95.0000, "estimated_amount": 11531, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 8497.23, "standard_charge_percentage": 70.0000, "estimated_amount": 8497, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 9711.12, "standard_charge_percentage": 80.0000, "estimated_amount": 9711, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 9711.12, "standard_charge_percentage": 80.0000, "estimated_amount": 9711, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 9711.12, "standard_charge_percentage": 80.0000, "estimated_amount": 9711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 4843.42, "standard_charge_percentage": 42.0000, "estimated_amount": 4843, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7114.65, "estimated_amount": 7114, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 4103.78, "estimated_amount": 4103, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 2272.38, "estimated_amount": 2272, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 8497.23, "standard_charge_percentage": 70.0000, "estimated_amount": 8497, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 9711.12, "standard_charge_percentage": 80.0000, "estimated_amount": 9711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 7470.38, "estimated_amount": 7470, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 9711.12, "standard_charge_percentage": 80.0000, "estimated_amount": 9711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 3155.25, "estimated_amount": 3155, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4945.39, "standard_charge_percentage": 42.0000, "estimated_amount": 4945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9711.12, "standard_charge_percentage": 80.0000, "estimated_amount": 9711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3641.67, "standard_charge_percentage": 30.0000, "estimated_amount": 3641, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Explore Wound,Neck", "code_information": [ { "code": "20100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3448.15, "discounted_cash": 722,"minimum": 282,"maximum": 3448.15,"payers_information":[{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2930.93, "standard_charge_percentage": 85.0000, "estimated_amount": 2930, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 775.99, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 707.93, "estimated_amount": 707, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1404.78, "standard_charge_percentage": 42.0000, "estimated_amount": 1404, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1034.44, "standard_charge_percentage": 30.0000, "estimated_amount": 1034, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1448.22, "standard_charge_percentage": 42.0000, "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1375.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1375, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1404.78, "standard_charge_percentage": 42.0000, "estimated_amount": 1404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1307.06, "estimated_amount": 1307, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3448.15, "estimated_amount": 3448, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1683.73, "standard_charge_percentage": 48.8300, "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1724.08, "standard_charge_percentage": 50.0000, "estimated_amount": 1724, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 493.9, "estimated_amount": 493, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 583.35, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1448.22, "standard_charge_percentage": 42.0000, "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3275.74, "standard_charge_percentage": 95.0000, "estimated_amount": 3275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2586.11, "standard_charge_percentage": 75.0000, "estimated_amount": 2586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 592.24, "estimated_amount": 592, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 566.68, "estimated_amount": 566, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1404.78, "standard_charge_percentage": 42.0000, "estimated_amount": 1404, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1433.74, "standard_charge_percentage": 42.0000, "estimated_amount": 1433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1375.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1375, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1404.78, "standard_charge_percentage": 42.0000, "estimated_amount": 1404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 3017.13, "standard_charge_percentage": 87.5000, "estimated_amount": 3017, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 777.8, "estimated_amount": 777, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 707.93, "estimated_amount": 707, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 566.68, "estimated_amount": 566, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2068.89, "standard_charge_percentage": 60.0000, "estimated_amount": 2068, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Explore Wound,Chest", "code_information": [ { "code": "20101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10687.5, "discounted_cash": 2594,"minimum": 519.96,"maximum": 10153.1,"payers_information":[{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1979.7, "estimated_amount": 1979, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 9618.75, "standard_charge_percentage": 90.0000, "estimated_amount": 9618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3206.25, "standard_charge_percentage": 30.0000, "estimated_amount": 3206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 9618.75, "standard_charge_percentage": 90.0000, "estimated_amount": 9618, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 9618.75, "standard_charge_percentage": 90.0000, "estimated_amount": 9618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4488.75, "standard_charge_percentage": 42.0000, "estimated_amount": 4488, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1979.7, "estimated_amount": 1979, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2405.16, "estimated_amount": 2405, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4488.75, "standard_charge_percentage": 42.0000, "estimated_amount": 4488, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4443.86, "standard_charge_percentage": 42.0000, "estimated_amount": 4443, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5218.71, "standard_charge_percentage": 48.8300, "estimated_amount": 5218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 10153.1, "standard_charge_percentage": 95.0000, "estimated_amount": 10153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 8015.63, "standard_charge_percentage": 75.0000, "estimated_amount": 8015, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4051.2, "estimated_amount": 4051, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4354.09, "standard_charge_percentage": 42.0000, "estimated_amount": 4354, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 7481.25, "standard_charge_percentage": 70.0000, "estimated_amount": 7481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 4264.31, "standard_charge_percentage": 42.0000, "estimated_amount": 4264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2793.85, "estimated_amount": 2793, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 7481.25, "standard_charge_percentage": 70.0000, "estimated_amount": 7481, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5343.75, "standard_charge_percentage": 50.0000, "estimated_amount": 5343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1774.1, "estimated_amount": 1774, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2127.32, "estimated_amount": 2127, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 8550, "standard_charge_percentage": 80.0000, "estimated_amount": 8550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2095.39, "estimated_amount": 2095, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6412.5, "standard_charge_percentage": 60.0000, "estimated_amount": 6412, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 9084.38, "standard_charge_percentage": 85.0000, "estimated_amount": 9084, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 7481.25, "standard_charge_percentage": 70.0000, "estimated_amount": 7481, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 9351.56, "standard_charge_percentage": 87.5000, "estimated_amount": 9351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 4264.31, "standard_charge_percentage": 42.0000, "estimated_amount": 4264, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Explore Wound Abdomen/Flank/Back", "code_information": [ { "code": "20102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7056.05, "discounted_cash": 2594,"minimum": 519.96,"maximum": 6703.25,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6174.04, "standard_charge_percentage": 87.5000, "estimated_amount": 6174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1979.7, "estimated_amount": 1979, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1979.7, "estimated_amount": 1979, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3528.03, "standard_charge_percentage": 50.0000, "estimated_amount": 3528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2963.54, "standard_charge_percentage": 42.0000, "estimated_amount": 2963, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5997.64, "standard_charge_percentage": 85.0000, "estimated_amount": 5997, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5292.04, "standard_charge_percentage": 75.0000, "estimated_amount": 5292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1774.1, "estimated_amount": 1774, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2793.85, "estimated_amount": 2793, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6703.25, "standard_charge_percentage": 95.0000, "estimated_amount": 6703, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2815.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4939.23, "standard_charge_percentage": 70.0000, "estimated_amount": 4939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3445.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3445, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2933.91, "standard_charge_percentage": 42.0000, "estimated_amount": 2933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5644.84, "standard_charge_percentage": 80.0000, "estimated_amount": 5644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2127.32, "estimated_amount": 2127, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2815.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2815, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2874.63, "standard_charge_percentage": 42.0000, "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2674.68, "estimated_amount": 2674, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2095.39, "estimated_amount": 2095, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2963.54, "standard_charge_percentage": 42.0000, "estimated_amount": 2963, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6350.44, "standard_charge_percentage": 90.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2116.82, "standard_charge_percentage": 30.0000, "estimated_amount": 2116, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1587.93, "estimated_amount": 1587, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2035.52, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4233.63, "standard_charge_percentage": 60.0000, "estimated_amount": 4233, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1995.61, "estimated_amount": 1995, "methodology": "fee schedule" }]}]} , { "description": "Hc Explore Wound Extremity", "code_information": [ { "code": "20103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 4474.4,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1501.29, "estimated_amount": 1501, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1501.29, "estimated_amount": 1501, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" }]}]} , { "description": "Muscle biopsy superficial", "code_information": [ { "code": "20200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Deep Muscle Biopsy", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 4059,"minimum": 1150,"maximum": 6717.83,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" }]}]} , { "description": "INJECT INTO SPINAL ARTERY", "code_information": [ { "code": "20206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 4709.9,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 694.3, "estimated_amount": 694, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 694.3, "estimated_amount": 694, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4709.9, "estimated_amount": 4709, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" }]}]} , { "description": "EPI STEROID INJ CERV/THORA-PC", "code_information": [ { "code": "20220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 4474.4,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" }]}]} , { "description": "Bone biopsy trocarndl deep", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Bone Biopsy,Excisional Superf", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" }]}]} , { "description": "Hc Bone Biopsy,Excisional Deep", "code_information": [ { "code": "20245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 4059,"minimum": 1216,"maximum": 6717.83,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4687.5, "discounted_cash": 2100,"minimum": 519.96,"maximum": 4687.5,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1406.25, "standard_charge_percentage": 30.0000, "estimated_amount": 1406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3750, "standard_charge_percentage": 80.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1909.69, "standard_charge_percentage": 42.0000, "estimated_amount": 1909, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4101.56, "standard_charge_percentage": 87.5000, "estimated_amount": 4101, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4453.13, "standard_charge_percentage": 95.0000, "estimated_amount": 4453, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2288.91, "standard_charge_percentage": 48.8300, "estimated_amount": 2288, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4218.75, "standard_charge_percentage": 90.0000, "estimated_amount": 4218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1648.33, "estimated_amount": 1648, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3750, "standard_charge_percentage": 80.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3750, "standard_charge_percentage": 80.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3750, "standard_charge_percentage": 80.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1909.69, "standard_charge_percentage": 42.0000, "estimated_amount": 1909, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2812.5, "standard_charge_percentage": 60.0000, "estimated_amount": 2812, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1870.31, "standard_charge_percentage": 42.0000, "estimated_amount": 1870, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2343.75, "standard_charge_percentage": 50.0000, "estimated_amount": 2343, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3750, "standard_charge_percentage": 80.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3515.63, "standard_charge_percentage": 75.0000, "estimated_amount": 3515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 707.93, "estimated_amount": 707, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4218.75, "standard_charge_percentage": 90.0000, "estimated_amount": 4218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 70.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 775.99, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3750, "standard_charge_percentage": 80.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3750, "standard_charge_percentage": 80.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 70.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2262.41, "estimated_amount": 2262, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3750, "standard_charge_percentage": 80.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1909.69, "standard_charge_percentage": 42.0000, "estimated_amount": 1909, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4687.5, "estimated_amount": 4687, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1436.63, "estimated_amount": 1436, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 707.93, "estimated_amount": 707, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3750, "standard_charge_percentage": 80.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1307.06, "estimated_amount": 1307, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1648.33, "estimated_amount": 1648, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1696.81, "estimated_amount": 1696, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 42.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1722.67, "estimated_amount": 1722, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 3984.38, "standard_charge_percentage": 85.0000, "estimated_amount": 3984, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3750, "standard_charge_percentage": 80.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1909.69, "standard_charge_percentage": 42.0000, "estimated_amount": 1909, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 70.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4218.75, "standard_charge_percentage": 90.0000, "estimated_amount": 4218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1870.31, "standard_charge_percentage": 42.0000, "estimated_amount": 1870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 42.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1949.06, "standard_charge_percentage": 42.0000, "estimated_amount": 1949, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Inject Sinus Tract For Dx W Xray", "code_information": [ { "code": "20501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 806.92,"minimum": 242.08,"maximum": 806.92,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 645.54, "standard_charge_percentage": 80.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 806.92, "estimated_amount": 806, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 321.96, "standard_charge_percentage": 42.0000, "estimated_amount": 321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 645.54, "standard_charge_percentage": 80.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 685.88, "standard_charge_percentage": 85.0000, "estimated_amount": 685, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 484.15, "standard_charge_percentage": 60.0000, "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 645.54, "standard_charge_percentage": 80.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 806.92, "estimated_amount": 806, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 605.19, "standard_charge_percentage": 75.0000, "estimated_amount": 605, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 726.23, "standard_charge_percentage": 90.0000, "estimated_amount": 726, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 564.84, "standard_charge_percentage": 70.0000, "estimated_amount": 564, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 335.52, "standard_charge_percentage": 42.0000, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 645.54, "standard_charge_percentage": 80.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 645.54, "standard_charge_percentage": 80.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 645.54, "standard_charge_percentage": 80.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 706.05, "standard_charge_percentage": 87.5000, "estimated_amount": 706, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 564.84, "standard_charge_percentage": 70.0000, "estimated_amount": 564, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 645.54, "standard_charge_percentage": 80.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 726.23, "standard_charge_percentage": 90.0000, "estimated_amount": 726, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 321.96, "standard_charge_percentage": 42.0000, "estimated_amount": 321, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 766.57, "standard_charge_percentage": 95.0000, "estimated_amount": 766, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 403.46, "standard_charge_percentage": 50.0000, "estimated_amount": 403, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 645.54, "standard_charge_percentage": 80.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 328.74, "standard_charge_percentage": 42.0000, "estimated_amount": 328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 338.91, "standard_charge_percentage": 42.0000, "estimated_amount": 338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 242.08, "standard_charge_percentage": 30.0000, "estimated_amount": 242, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 328.74, "standard_charge_percentage": 42.0000, "estimated_amount": 328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 564.84, "standard_charge_percentage": 70.0000, "estimated_amount": 564, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 726.23, "standard_charge_percentage": 90.0000, "estimated_amount": 726, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 645.54, "standard_charge_percentage": 80.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 328.74, "standard_charge_percentage": 42.0000, "estimated_amount": 328, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 338.91, "standard_charge_percentage": 42.0000, "estimated_amount": 338, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 328.74, "standard_charge_percentage": 42.0000, "estimated_amount": 328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 645.54, "standard_charge_percentage": 80.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Remove Fb Musc/Tendon, Simple", "code_information": [ { "code": "20520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 256.43,"maximum": 4474.4,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Removal Of Foreign Body Deep/Complex", "code_information": [ { "code": "20525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 4059,"minimum": 1216,"maximum": 6717.83,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" }]}]} , { "description": "Hc Inject Carpal Tunnel", "code_information": [ { "code": "20526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.8, "discounted_cash": 418,"minimum": 112.04,"maximum": 1118.8,"payers_information":[{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 450.86, "estimated_amount": 450, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 335.64, "standard_charge_percentage": 30.0000, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 338.14, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 469.9, "standard_charge_percentage": 42.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 839.1, "standard_charge_percentage": 75.0000, "estimated_amount": 839, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 559.4, "standard_charge_percentage": 50.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1062.86, "standard_charge_percentage": 95.0000, "estimated_amount": 1062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 446.4, "standard_charge_percentage": 42.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 446.4, "standard_charge_percentage": 42.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 286.29, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 546.31, "standard_charge_percentage": 48.8300, "estimated_amount": 546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 978.95, "standard_charge_percentage": 87.5000, "estimated_amount": 978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 469.9, "standard_charge_percentage": 42.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 343.29, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 671.28, "standard_charge_percentage": 60.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 465.2, "standard_charge_percentage": 42.0000, "estimated_amount": 465, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 950.98, "standard_charge_percentage": 85.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" }]}]} , { "description": "Hc Inject Tendon Sheath/Ligament", "code_information": [ { "code": "20550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.8, "discounted_cash": 418,"minimum": 112.04,"maximum": 1118.8,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 446.4, "standard_charge_percentage": 42.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 559.4, "standard_charge_percentage": 50.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 671.28, "standard_charge_percentage": 60.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 465.2, "standard_charge_percentage": 42.0000, "estimated_amount": 465, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 839.1, "standard_charge_percentage": 75.0000, "estimated_amount": 839, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 950.98, "standard_charge_percentage": 85.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 446.4, "standard_charge_percentage": 42.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 978.95, "standard_charge_percentage": 87.5000, "estimated_amount": 978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 335.64, "standard_charge_percentage": 30.0000, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 469.9, "standard_charge_percentage": 42.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1062.86, "standard_charge_percentage": 95.0000, "estimated_amount": 1062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 286.29, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 546.31, "standard_charge_percentage": 48.8300, "estimated_amount": 546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 450.86, "estimated_amount": 450, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 469.9, "standard_charge_percentage": 42.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 343.29, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 338.14, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" }]}]} , { "description": "Hc Inject Tendon Origin/Insert", "code_information": [ { "code": "20551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.8, "discounted_cash": 418,"minimum": 112.04,"maximum": 1118.8,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 335.64, "standard_charge_percentage": 30.0000, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 469.9, "standard_charge_percentage": 42.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 671.28, "standard_charge_percentage": 60.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 839.1, "standard_charge_percentage": 75.0000, "estimated_amount": 839, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 546.31, "standard_charge_percentage": 48.8300, "estimated_amount": 546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 450.86, "estimated_amount": 450, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 343.29, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 950.98, "standard_charge_percentage": 85.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 978.95, "standard_charge_percentage": 87.5000, "estimated_amount": 978, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 286.29, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 338.14, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 559.4, "standard_charge_percentage": 50.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 465.2, "standard_charge_percentage": 42.0000, "estimated_amount": 465, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 469.9, "standard_charge_percentage": 42.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 446.4, "standard_charge_percentage": 42.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 446.4, "standard_charge_percentage": 42.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1062.86, "standard_charge_percentage": 95.0000, "estimated_amount": 1062, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Inject Trigger Point1-2 Muscle", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.8, "discounted_cash": 418,"minimum": 112.04,"maximum": 1118.8,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 335.64, "standard_charge_percentage": 30.0000, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 338.14, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 469.9, "standard_charge_percentage": 42.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1062.86, "standard_charge_percentage": 95.0000, "estimated_amount": 1062, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 343.29, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 950.98, "standard_charge_percentage": 85.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 839.1, "standard_charge_percentage": 75.0000, "estimated_amount": 839, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 446.4, "standard_charge_percentage": 42.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 450.86, "estimated_amount": 450, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 978.95, "standard_charge_percentage": 87.5000, "estimated_amount": 978, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 465.2, "standard_charge_percentage": 42.0000, "estimated_amount": 465, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 446.4, "standard_charge_percentage": 42.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 469.9, "standard_charge_percentage": 42.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 671.28, "standard_charge_percentage": 60.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 559.4, "standard_charge_percentage": 50.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 286.29, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 546.31, "standard_charge_percentage": 48.8300, "estimated_amount": 546, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Inject Trigger Points, > 3", "code_information": [ { "code": "20553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.8, "discounted_cash": 418,"minimum": 112.04,"maximum": 1118.8,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 469.9, "standard_charge_percentage": 42.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 465.2, "standard_charge_percentage": 42.0000, "estimated_amount": 465, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 950.98, "standard_charge_percentage": 85.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 469.9, "standard_charge_percentage": 42.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 343.29, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 335.64, "standard_charge_percentage": 30.0000, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 338.14, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 839.1, "standard_charge_percentage": 75.0000, "estimated_amount": 839, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 446.4, "standard_charge_percentage": 42.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 446.4, "standard_charge_percentage": 42.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 286.29, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 546.31, "standard_charge_percentage": 48.8300, "estimated_amount": 546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 671.28, "standard_charge_percentage": 60.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 978.95, "standard_charge_percentage": 87.5000, "estimated_amount": 978, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 450.86, "estimated_amount": 450, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 559.4, "standard_charge_percentage": 50.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1062.86, "standard_charge_percentage": 95.0000, "estimated_amount": 1062, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" }]}]} , { "description": "Hc Drain/Inject Small Joint/Bursa", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1220, "discounted_cash": 418,"minimum": 112.04,"maximum": 1220,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 366, "standard_charge_percentage": 30.0000, "estimated_amount": 366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 497.03, "standard_charge_percentage": 42.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1220, "estimated_amount": 1220, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 512.4, "standard_charge_percentage": 42.0000, "estimated_amount": 512, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 497.03, "standard_charge_percentage": 42.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 507.28, "standard_charge_percentage": 42.0000, "estimated_amount": 507, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1159, "standard_charge_percentage": 95.0000, "estimated_amount": 1159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 343.29, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 595.73, "standard_charge_percentage": 48.8300, "estimated_amount": 595, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 732, "standard_charge_percentage": 60.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1067.5, "standard_charge_percentage": 87.5000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 512.4, "standard_charge_percentage": 42.0000, "estimated_amount": 512, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 610, "standard_charge_percentage": 50.0000, "estimated_amount": 610, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 497.03, "standard_charge_percentage": 42.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1037, "standard_charge_percentage": 85.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 915, "standard_charge_percentage": 75.0000, "estimated_amount": 915, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1098, "standard_charge_percentage": 90.0000, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1098, "standard_charge_percentage": 90.0000, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 486.78, "standard_charge_percentage": 42.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1220, "estimated_amount": 1220, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1098, "standard_charge_percentage": 90.0000, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 450.86, "estimated_amount": 450, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 497.03, "standard_charge_percentage": 42.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 854, "standard_charge_percentage": 70.0000, "estimated_amount": 854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 486.78, "standard_charge_percentage": 42.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 854, "standard_charge_percentage": 70.0000, "estimated_amount": 854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 854, "standard_charge_percentage": 70.0000, "estimated_amount": 854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 338.14, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 286.29, "estimated_amount": 286, "methodology": "fee schedule" }]}]} , { "description": "Hc Arthrocnt Aspir&/Inj Small Jt/Bursaw/Us Rec Rprt", "code_information": [ { "code": "20604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1334.15, "discounted_cash": 418,"minimum": 251.78,"maximum": 1334.15,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1067.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1200.74, "standard_charge_percentage": 90.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 343.29, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 450.86, "estimated_amount": 450, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1200.74, "standard_charge_percentage": 90.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 667.08, "standard_charge_percentage": 50.0000, "estimated_amount": 667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1067.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1067.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 560.34, "standard_charge_percentage": 42.0000, "estimated_amount": 560, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1067.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1000.61, "standard_charge_percentage": 75.0000, "estimated_amount": 1000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 543.53, "standard_charge_percentage": 42.0000, "estimated_amount": 543, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1267.44, "standard_charge_percentage": 95.0000, "estimated_amount": 1267, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 554.74, "standard_charge_percentage": 42.0000, "estimated_amount": 554, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 400.25, "standard_charge_percentage": 30.0000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1067.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 800.49, "standard_charge_percentage": 60.0000, "estimated_amount": 800, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 543.53, "standard_charge_percentage": 42.0000, "estimated_amount": 543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 933.9, "standard_charge_percentage": 70.0000, "estimated_amount": 933, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 338.14, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 286.29, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 933.9, "standard_charge_percentage": 70.0000, "estimated_amount": 933, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1334.15, "estimated_amount": 1334, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1134.03, "standard_charge_percentage": 85.0000, "estimated_amount": 1134, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 543.53, "standard_charge_percentage": 42.0000, "estimated_amount": 543, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1067.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 651.47, "standard_charge_percentage": 48.8300, "estimated_amount": 651, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 267.6, "estimated_amount": 267, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1067.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1167.38, "standard_charge_percentage": 87.5000, "estimated_amount": 1167, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 560.34, "standard_charge_percentage": 42.0000, "estimated_amount": 560, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 933.9, "standard_charge_percentage": 70.0000, "estimated_amount": 933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1067.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 532.33, "standard_charge_percentage": 42.0000, "estimated_amount": 532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1067.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 667.08, "standard_charge_percentage": 50.0000, "estimated_amount": 667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 267.6, "estimated_amount": 267, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1334.15, "estimated_amount": 1334, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 543.53, "standard_charge_percentage": 42.0000, "estimated_amount": 543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 532.33, "standard_charge_percentage": 42.0000, "estimated_amount": 532, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1200.74, "standard_charge_percentage": 90.0000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1067.32, "standard_charge_percentage": 80.0000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" }]}]} , { "description": "DRAININJECT JOINTBURSA", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1220, "discounted_cash": 418,"minimum": 112.04,"maximum": 1220,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 497.03, "standard_charge_percentage": 42.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1220, "estimated_amount": 1220, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 915, "standard_charge_percentage": 75.0000, "estimated_amount": 915, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1098, "standard_charge_percentage": 90.0000, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 486.78, "standard_charge_percentage": 42.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1098, "standard_charge_percentage": 90.0000, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 854, "standard_charge_percentage": 70.0000, "estimated_amount": 854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 854, "standard_charge_percentage": 70.0000, "estimated_amount": 854, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1220, "estimated_amount": 1220, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1098, "standard_charge_percentage": 90.0000, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 610, "standard_charge_percentage": 50.0000, "estimated_amount": 610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 497.03, "standard_charge_percentage": 42.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1067.5, "standard_charge_percentage": 87.5000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 343.29, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 595.73, "standard_charge_percentage": 48.8300, "estimated_amount": 595, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 497.03, "standard_charge_percentage": 42.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 732, "standard_charge_percentage": 60.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 507.28, "standard_charge_percentage": 42.0000, "estimated_amount": 507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 497.03, "standard_charge_percentage": 42.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 286.29, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 512.4, "standard_charge_percentage": 42.0000, "estimated_amount": 512, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 512.4, "standard_charge_percentage": 42.0000, "estimated_amount": 512, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 854, "standard_charge_percentage": 70.0000, "estimated_amount": 854, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 486.78, "standard_charge_percentage": 42.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1037, "standard_charge_percentage": 85.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 338.14, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 366, "standard_charge_percentage": 30.0000, "estimated_amount": 366, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1159, "standard_charge_percentage": 95.0000, "estimated_amount": 1159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 450.86, "estimated_amount": 450, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" }]}]} , { "description": "Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/Us", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.95, "discounted_cash": 982,"minimum": 251.78,"maximum": 2535.95,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 770.62, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 755.51, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2409.15, "standard_charge_percentage": 95.0000, "estimated_amount": 2409, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 755.51, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 527.22, "standard_charge_percentage": 21.0000, "estimated_amount": 527, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1267.97, "standard_charge_percentage": 50.0000, "estimated_amount": 1267, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1238.3, "standard_charge_percentage": 48.8300, "estimated_amount": 1238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 805.37, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1901.96, "standard_charge_percentage": 75.0000, "estimated_amount": 1901, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1521.57, "standard_charge_percentage": 60.0000, "estimated_amount": 1521, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2028.76, "standard_charge_percentage": 80.0000, "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2535.95, "estimated_amount": 2535, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 755.51, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2028.76, "standard_charge_percentage": 80.0000, "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2028.76, "standard_charge_percentage": 80.0000, "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 532.55, "standard_charge_percentage": 21.0000, "estimated_amount": 532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1775.16, "standard_charge_percentage": 70.0000, "estimated_amount": 1775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 755.51, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 755.51, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1267.97, "standard_charge_percentage": 50.0000, "estimated_amount": 1267, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 793.29, "estimated_amount": 793, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 532.55, "standard_charge_percentage": 21.0000, "estimated_amount": 532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1775.16, "standard_charge_percentage": 70.0000, "estimated_amount": 1775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2028.76, "standard_charge_percentage": 80.0000, "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 755.51, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2028.76, "standard_charge_percentage": 80.0000, "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 755.51, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2218.96, "standard_charge_percentage": 87.5000, "estimated_amount": 2218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 755.51, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2282.35, "standard_charge_percentage": 90.0000, "estimated_amount": 2282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 755.51, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2028.76, "standard_charge_percentage": 80.0000, "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 755.51, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 760.78, "standard_charge_percentage": 30.0000, "estimated_amount": 760, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 267.6, "estimated_amount": 267, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 505.92, "standard_charge_percentage": 21.0000, "estimated_amount": 505, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2028.76, "standard_charge_percentage": 80.0000, "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 516.57, "standard_charge_percentage": 21.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1057.71, "estimated_amount": 1057, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 671.65, "estimated_amount": 671, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2028.76, "standard_charge_percentage": 80.0000, "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 900.26, "standard_charge_percentage": 35.5000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 755.51, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2282.35, "standard_charge_percentage": 90.0000, "estimated_amount": 2282, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 516.57, "standard_charge_percentage": 21.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2028.76, "standard_charge_percentage": 80.0000, "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 770.62, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 516.57, "standard_charge_percentage": 21.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2028.76, "standard_charge_percentage": 80.0000, "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 505.92, "standard_charge_percentage": 21.0000, "estimated_amount": 505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 267.6, "estimated_amount": 267, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2282.35, "standard_charge_percentage": 90.0000, "estimated_amount": 2282, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2155.56, "standard_charge_percentage": 85.0000, "estimated_amount": 2155, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 516.57, "standard_charge_percentage": 21.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1775.16, "standard_charge_percentage": 70.0000, "estimated_amount": 1775, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Asp/Drain Large Joint/Bursa", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1220, "discounted_cash": 418,"minimum": 112.04,"maximum": 1220,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 497.03, "standard_charge_percentage": 42.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1037, "standard_charge_percentage": 85.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1220, "estimated_amount": 1220, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 338.14, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 512.4, "standard_charge_percentage": 42.0000, "estimated_amount": 512, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 486.78, "standard_charge_percentage": 42.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1098, "standard_charge_percentage": 90.0000, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 507.28, "standard_charge_percentage": 42.0000, "estimated_amount": 507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 595.73, "standard_charge_percentage": 48.8300, "estimated_amount": 595, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1220, "estimated_amount": 1220, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 343.29, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 497.03, "standard_charge_percentage": 42.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 366, "standard_charge_percentage": 30.0000, "estimated_amount": 366, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1067.5, "standard_charge_percentage": 87.5000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 497.03, "standard_charge_percentage": 42.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 497.03, "standard_charge_percentage": 42.0000, "estimated_amount": 497, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 610, "standard_charge_percentage": 50.0000, "estimated_amount": 610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 732, "standard_charge_percentage": 60.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 512.4, "standard_charge_percentage": 42.0000, "estimated_amount": 512, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1098, "standard_charge_percentage": 90.0000, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 854, "standard_charge_percentage": 70.0000, "estimated_amount": 854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 854, "standard_charge_percentage": 70.0000, "estimated_amount": 854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 450.86, "estimated_amount": 450, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 915, "standard_charge_percentage": 75.0000, "estimated_amount": 915, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1098, "standard_charge_percentage": 90.0000, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 486.78, "standard_charge_percentage": 42.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 286.29, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1159, "standard_charge_percentage": 95.0000, "estimated_amount": 1159, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 976, "standard_charge_percentage": 80.0000, "estimated_amount": 976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 854, "standard_charge_percentage": 70.0000, "estimated_amount": 854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" }]}]} , { "description": "Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/Us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1544, "discounted_cash": 418,"minimum": 251.78,"maximum": 1544,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1080.8, "standard_charge_percentage": 70.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 629.03, "standard_charge_percentage": 42.0000, "estimated_amount": 629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 772, "standard_charge_percentage": 50.0000, "estimated_amount": 772, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1312.4, "standard_charge_percentage": 85.0000, "estimated_amount": 1312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1080.8, "standard_charge_percentage": 70.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1389.6, "standard_charge_percentage": 90.0000, "estimated_amount": 1389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 648.48, "standard_charge_percentage": 42.0000, "estimated_amount": 648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 616.06, "standard_charge_percentage": 42.0000, "estimated_amount": 616, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 642, "standard_charge_percentage": 42.0000, "estimated_amount": 642, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 286.29, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1351, "standard_charge_percentage": 87.5000, "estimated_amount": 1351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1080.8, "standard_charge_percentage": 70.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 267.6, "estimated_amount": 267, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1389.6, "standard_charge_percentage": 90.0000, "estimated_amount": 1389, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 629.03, "standard_charge_percentage": 42.0000, "estimated_amount": 629, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 629.03, "standard_charge_percentage": 42.0000, "estimated_amount": 629, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1544, "estimated_amount": 1544, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 450.86, "estimated_amount": 450, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 648.48, "standard_charge_percentage": 42.0000, "estimated_amount": 648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1389.6, "standard_charge_percentage": 90.0000, "estimated_amount": 1389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 267.6, "estimated_amount": 267, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1158, "standard_charge_percentage": 75.0000, "estimated_amount": 1158, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 753.94, "standard_charge_percentage": 48.8300, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 343.29, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 926.4, "standard_charge_percentage": 60.0000, "estimated_amount": 926, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1466.8, "standard_charge_percentage": 95.0000, "estimated_amount": 1466, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 629.03, "standard_charge_percentage": 42.0000, "estimated_amount": 629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 338.14, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 463.2, "standard_charge_percentage": 30.0000, "estimated_amount": 463, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 616.06, "standard_charge_percentage": 42.0000, "estimated_amount": 616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 772, "standard_charge_percentage": 50.0000, "estimated_amount": 772, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Aspirat/Injection Ganglion Cyst(S)", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.8, "discounted_cash": 418,"minimum": 112.04,"maximum": 6234.38,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 559.4, "standard_charge_percentage": 50.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 286.29, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 469.9, "standard_charge_percentage": 42.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 671.28, "standard_charge_percentage": 60.0000, "estimated_amount": 671, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 335.64, "standard_charge_percentage": 30.0000, "estimated_amount": 335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 450.86, "estimated_amount": 450, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 338.14, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 978.95, "standard_charge_percentage": 87.5000, "estimated_amount": 978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 343.29, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 446.4, "standard_charge_percentage": 42.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 839.1, "standard_charge_percentage": 75.0000, "estimated_amount": 839, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 251.78, "estimated_amount": 251, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 328.48, "estimated_amount": 328, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 450.86, "estimated_amount": 450, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1062.86, "standard_charge_percentage": 95.0000, "estimated_amount": 1062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 446.4, "standard_charge_percentage": 42.0000, "estimated_amount": 446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 783.16, "standard_charge_percentage": 70.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1118.8, "estimated_amount": 1118, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 469.9, "standard_charge_percentage": 42.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 424.09, "estimated_amount": 424, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 343.29, "estimated_amount": 343, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 950.98, "standard_charge_percentage": 85.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1006.92, "standard_charge_percentage": 90.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 338.14, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 233.73, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 465.2, "standard_charge_percentage": 42.0000, "estimated_amount": 465, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 286.29, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 546.31, "standard_charge_percentage": 48.8300, "estimated_amount": 546, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 895.04, "standard_charge_percentage": 80.0000, "estimated_amount": 895, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 455.8, "standard_charge_percentage": 42.0000, "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 322.04, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Asp & Inj Bone Cyst", "code_information": [ { "code": "20615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 997,"minimum": 256.43,"maximum": 4474.4,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 805.96, "estimated_amount": 805, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 818.24, "estimated_amount": 818, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.34, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.34, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1074.61, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 782.93, "estimated_amount": 782, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 682.38, "estimated_amount": 682, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 767.58, "estimated_amount": 767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" }]}]} , { "description": "INSERT AND REMOVE BONE PIN", "code_information": [ { "code": "20650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14152, "discounted_cash": 4601,"minimum": 1287,"maximum": 13444.4,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4955.62, "estimated_amount": 4955, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 9906.4, "standard_charge_percentage": 70.0000, "estimated_amount": 9906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3773.35, "estimated_amount": 3773, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3146.82, "estimated_amount": 3146, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 12736.8, "standard_charge_percentage": 90.0000, "estimated_amount": 12736, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 11321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 10614, "standard_charge_percentage": 75.0000, "estimated_amount": 10614, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 11321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11321, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4540.39, "estimated_amount": 4540, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 11321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11321, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 11321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11321, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3610.52, "estimated_amount": 3610, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 9906.4, "standard_charge_percentage": 70.0000, "estimated_amount": 9906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 5646.65, "standard_charge_percentage": 42.0000, "estimated_amount": 5646, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 13444.4, "standard_charge_percentage": 95.0000, "estimated_amount": 13444, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 5765.52, "standard_charge_percentage": 42.0000, "estimated_amount": 5765, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 5765.52, "standard_charge_percentage": 42.0000, "estimated_amount": 5765, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5854, "estimated_amount": 5854, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 12029.2, "standard_charge_percentage": 85.0000, "estimated_amount": 12029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 8491.2, "standard_charge_percentage": 60.0000, "estimated_amount": 8491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 11321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2046.94, "estimated_amount": 2046, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 12736.8, "standard_charge_percentage": 90.0000, "estimated_amount": 12736, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2046.94, "estimated_amount": 2046, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2695.59, "estimated_amount": 2695, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 5765.52, "standard_charge_percentage": 42.0000, "estimated_amount": 5765, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 9906.4, "standard_charge_percentage": 70.0000, "estimated_amount": 9906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 12383, "standard_charge_percentage": 87.5000, "estimated_amount": 12383, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 5646.65, "standard_charge_percentage": 42.0000, "estimated_amount": 5646, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 5943.84, "standard_charge_percentage": 42.0000, "estimated_amount": 5943, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 11321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4245.6, "standard_charge_percentage": 30.0000, "estimated_amount": 4245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3610.52, "estimated_amount": 3610, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 11321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11321, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 12736.8, "standard_charge_percentage": 90.0000, "estimated_amount": 12736, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1287, "estimated_amount": 1287, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 5943.84, "standard_charge_percentage": 42.0000, "estimated_amount": 5943, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 5884.4, "standard_charge_percentage": 42.0000, "estimated_amount": 5884, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3716.72, "estimated_amount": 3716, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 11321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 6910.42, "standard_charge_percentage": 48.8300, "estimated_amount": 6910, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 5765.52, "standard_charge_percentage": 42.0000, "estimated_amount": 5765, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 7076, "standard_charge_percentage": 50.0000, "estimated_amount": 7076, "methodology": "percent of total billed charges" }]}]} , { "description": "APPLY REM FIXATION DEVICE", "code_information": [ { "code": "20660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 256.43,"maximum": 5482.25,"payers_information":[{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2187.42, "standard_charge_percentage": 42.0000, "estimated_amount": 2187, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2233.47, "standard_charge_percentage": 42.0000, "estimated_amount": 2233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2302.55, "standard_charge_percentage": 42.0000, "estimated_amount": 2302, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2302.55, "standard_charge_percentage": 42.0000, "estimated_amount": 2302, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2187.42, "standard_charge_percentage": 42.0000, "estimated_amount": 2187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2233.47, "standard_charge_percentage": 42.0000, "estimated_amount": 2233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5482.25, "estimated_amount": 5482, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2233.47, "standard_charge_percentage": 42.0000, "estimated_amount": 2233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2233.47, "standard_charge_percentage": 42.0000, "estimated_amount": 2233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 576.46, "estimated_amount": 576, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2279.52, "standard_charge_percentage": 42.0000, "estimated_amount": 2279, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" }]}]} , { "description": "REMOVAL IMPLANT SUPERFICIAL", "code_information": [ { "code": "20670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7154.76, "discounted_cash": 2297,"minimum": 519.96,"maximum": 6797.02,"payers_information":[{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3005, "standard_charge_percentage": 42.0000, "estimated_amount": 3005, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2914.85, "standard_charge_percentage": 42.0000, "estimated_amount": 2914, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5723.81, "standard_charge_percentage": 80.0000, "estimated_amount": 5723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5723.81, "standard_charge_percentage": 80.0000, "estimated_amount": 5723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2854.75, "standard_charge_percentage": 42.0000, "estimated_amount": 2854, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6439.28, "standard_charge_percentage": 90.0000, "estimated_amount": 6439, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5723.81, "standard_charge_percentage": 80.0000, "estimated_amount": 5723, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2974.95, "standard_charge_percentage": 42.0000, "estimated_amount": 2974, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2146.43, "standard_charge_percentage": 30.0000, "estimated_amount": 2146, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5723.81, "standard_charge_percentage": 80.0000, "estimated_amount": 5723, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3005, "standard_charge_percentage": 42.0000, "estimated_amount": 3005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2914.85, "standard_charge_percentage": 42.0000, "estimated_amount": 2914, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5723.81, "standard_charge_percentage": 80.0000, "estimated_amount": 5723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2854.75, "standard_charge_percentage": 42.0000, "estimated_amount": 2854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5008.33, "standard_charge_percentage": 70.0000, "estimated_amount": 5008, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5366.07, "standard_charge_percentage": 75.0000, "estimated_amount": 5366, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5723.81, "standard_charge_percentage": 80.0000, "estimated_amount": 5723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2914.85, "standard_charge_percentage": 42.0000, "estimated_amount": 2914, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6439.28, "standard_charge_percentage": 90.0000, "estimated_amount": 6439, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3577.38, "standard_charge_percentage": 50.0000, "estimated_amount": 3577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5723.81, "standard_charge_percentage": 80.0000, "estimated_amount": 5723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6439.28, "standard_charge_percentage": 90.0000, "estimated_amount": 6439, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6081.55, "standard_charge_percentage": 85.0000, "estimated_amount": 6081, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5723.81, "standard_charge_percentage": 80.0000, "estimated_amount": 5723, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2914.85, "standard_charge_percentage": 42.0000, "estimated_amount": 2914, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5723.81, "standard_charge_percentage": 80.0000, "estimated_amount": 5723, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5008.33, "standard_charge_percentage": 70.0000, "estimated_amount": 5008, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4292.86, "standard_charge_percentage": 60.0000, "estimated_amount": 4292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5008.33, "standard_charge_percentage": 70.0000, "estimated_amount": 5008, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3493.67, "standard_charge_percentage": 48.8300, "estimated_amount": 3493, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6797.02, "standard_charge_percentage": 95.0000, "estimated_amount": 6797, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5723.81, "standard_charge_percentage": 80.0000, "estimated_amount": 5723, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6260.41, "standard_charge_percentage": 87.5000, "estimated_amount": 6260, "methodology": "percent of total billed charges" }]}]} , { "description": "Removal of implant deep", "code_information": [ { "code": "20680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7986.89, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 7587.55,"payers_information":[{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3354.49, "standard_charge_percentage": 42.0000, "estimated_amount": 3354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5590.82, "standard_charge_percentage": 70.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6389.51, "standard_charge_percentage": 80.0000, "estimated_amount": 6389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6389.51, "standard_charge_percentage": 80.0000, "estimated_amount": 6389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3320.95, "standard_charge_percentage": 42.0000, "estimated_amount": 3320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5590.82, "standard_charge_percentage": 70.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6389.51, "standard_charge_percentage": 80.0000, "estimated_amount": 6389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3186.77, "standard_charge_percentage": 42.0000, "estimated_amount": 3186, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6389.51, "standard_charge_percentage": 80.0000, "estimated_amount": 6389, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7188.2, "standard_charge_percentage": 90.0000, "estimated_amount": 7188, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3900, "standard_charge_percentage": 48.8300, "estimated_amount": 3900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6988.53, "standard_charge_percentage": 87.5000, "estimated_amount": 6988, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6788.86, "standard_charge_percentage": 85.0000, "estimated_amount": 6788, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4792.13, "standard_charge_percentage": 60.0000, "estimated_amount": 4792, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6389.51, "standard_charge_percentage": 80.0000, "estimated_amount": 6389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5990.17, "standard_charge_percentage": 75.0000, "estimated_amount": 5990, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7188.2, "standard_charge_percentage": 90.0000, "estimated_amount": 7188, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7188.2, "standard_charge_percentage": 90.0000, "estimated_amount": 7188, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3253.86, "standard_charge_percentage": 42.0000, "estimated_amount": 3253, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2396.07, "standard_charge_percentage": 30.0000, "estimated_amount": 2396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6389.51, "standard_charge_percentage": 80.0000, "estimated_amount": 6389, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3253.86, "standard_charge_percentage": 42.0000, "estimated_amount": 3253, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6389.51, "standard_charge_percentage": 80.0000, "estimated_amount": 6389, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7587.55, "standard_charge_percentage": 95.0000, "estimated_amount": 7587, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3253.86, "standard_charge_percentage": 42.0000, "estimated_amount": 3253, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5590.82, "standard_charge_percentage": 70.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6389.51, "standard_charge_percentage": 80.0000, "estimated_amount": 6389, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3253.86, "standard_charge_percentage": 42.0000, "estimated_amount": 3253, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6389.51, "standard_charge_percentage": 80.0000, "estimated_amount": 6389, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3354.49, "standard_charge_percentage": 42.0000, "estimated_amount": 3354, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6389.51, "standard_charge_percentage": 80.0000, "estimated_amount": 6389, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3993.45, "standard_charge_percentage": 50.0000, "estimated_amount": 3993, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3186.77, "standard_charge_percentage": 42.0000, "estimated_amount": 3186, "methodology": "percent of total billed charges" }]}]} , { "description": "Appl Mltpln Uni Ext Fixj Sys", "code_information": [ { "code": "20692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8625, "discounted_cash": 18248,"minimum": 1287,"maximum": 8625,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3513.82, "standard_charge_percentage": 42.0000, "estimated_amount": 3513, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7762.5, "standard_charge_percentage": 90.0000, "estimated_amount": 7762, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6037.5, "standard_charge_percentage": 70.0000, "estimated_amount": 6037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7762.5, "standard_charge_percentage": 90.0000, "estimated_amount": 7762, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2587.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2808.22, "estimated_amount": 2808, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6900, "standard_charge_percentage": 80.0000, "estimated_amount": 6900, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3513.82, "standard_charge_percentage": 42.0000, "estimated_amount": 3513, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 6468.75, "standard_charge_percentage": 75.0000, "estimated_amount": 6468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6900, "standard_charge_percentage": 80.0000, "estimated_amount": 6900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6037.5, "standard_charge_percentage": 70.0000, "estimated_amount": 6037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 7948.7, "estimated_amount": 7948, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3513.82, "standard_charge_percentage": 42.0000, "estimated_amount": 3513, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3441.38, "standard_charge_percentage": 42.0000, "estimated_amount": 3441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3441.38, "standard_charge_percentage": 42.0000, "estimated_amount": 3441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3622.5, "standard_charge_percentage": 42.0000, "estimated_amount": 3622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6900, "standard_charge_percentage": 80.0000, "estimated_amount": 6900, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 7546.88, "standard_charge_percentage": 87.5000, "estimated_amount": 7546, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 7331.25, "standard_charge_percentage": 85.0000, "estimated_amount": 7331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5854, "estimated_amount": 5854, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6900, "standard_charge_percentage": 80.0000, "estimated_amount": 6900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7762.5, "standard_charge_percentage": 90.0000, "estimated_amount": 7762, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3622.5, "standard_charge_percentage": 42.0000, "estimated_amount": 3622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2808.22, "estimated_amount": 2808, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6037.5, "standard_charge_percentage": 70.0000, "estimated_amount": 6037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5175, "standard_charge_percentage": 60.0000, "estimated_amount": 5175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1287, "estimated_amount": 1287, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6900, "standard_charge_percentage": 80.0000, "estimated_amount": 6900, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3513.82, "standard_charge_percentage": 42.0000, "estimated_amount": 3513, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6900, "standard_charge_percentage": 80.0000, "estimated_amount": 6900, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6900, "standard_charge_percentage": 80.0000, "estimated_amount": 6900, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6900, "standard_charge_percentage": 80.0000, "estimated_amount": 6900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6900, "standard_charge_percentage": 80.0000, "estimated_amount": 6900, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4312.5, "standard_charge_percentage": 50.0000, "estimated_amount": 4312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 8625, "estimated_amount": 8625, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6900, "standard_charge_percentage": 80.0000, "estimated_amount": 6900, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3586.28, "standard_charge_percentage": 42.0000, "estimated_amount": 3586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 4211.59, "standard_charge_percentage": 48.8300, "estimated_amount": 4211, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 8193.75, "standard_charge_percentage": 95.0000, "estimated_amount": 8193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20694", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8639.44, "discounted_cash": 2269,"minimum": 519.96,"maximum": 8207.47,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5183.66, "standard_charge_percentage": 60.0000, "estimated_amount": 5183, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6911.55, "standard_charge_percentage": 80.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1637.5, "estimated_amount": 1637, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7775.5, "standard_charge_percentage": 90.0000, "estimated_amount": 7775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2046.94, "estimated_amount": 2046, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6911.55, "standard_charge_percentage": 80.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6047.61, "standard_charge_percentage": 70.0000, "estimated_amount": 6047, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2758.17, "estimated_amount": 2758, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6911.55, "standard_charge_percentage": 80.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3447.14, "standard_charge_percentage": 42.0000, "estimated_amount": 3447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2046.94, "estimated_amount": 2046, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6911.55, "standard_charge_percentage": 80.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 7559.51, "standard_charge_percentage": 87.5000, "estimated_amount": 7559, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4319.72, "standard_charge_percentage": 50.0000, "estimated_amount": 4319, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3519.71, "standard_charge_percentage": 42.0000, "estimated_amount": 3519, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3628.56, "standard_charge_percentage": 42.0000, "estimated_amount": 3628, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6911.55, "standard_charge_percentage": 80.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2591.83, "standard_charge_percentage": 30.0000, "estimated_amount": 2591, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6911.55, "standard_charge_percentage": 80.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 7343.52, "standard_charge_percentage": 85.0000, "estimated_amount": 7343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6047.61, "standard_charge_percentage": 70.0000, "estimated_amount": 6047, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7775.5, "standard_charge_percentage": 90.0000, "estimated_amount": 7775, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3628.56, "standard_charge_percentage": 42.0000, "estimated_amount": 3628, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 8207.47, "standard_charge_percentage": 95.0000, "estimated_amount": 8207, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3592.28, "standard_charge_percentage": 42.0000, "estimated_amount": 3592, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7775.5, "standard_charge_percentage": 90.0000, "estimated_amount": 7775, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3519.71, "standard_charge_percentage": 42.0000, "estimated_amount": 3519, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6047.61, "standard_charge_percentage": 70.0000, "estimated_amount": 6047, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6911.55, "standard_charge_percentage": 80.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 6479.58, "standard_charge_percentage": 75.0000, "estimated_amount": 6479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6911.55, "standard_charge_percentage": 80.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3519.71, "standard_charge_percentage": 42.0000, "estimated_amount": 3519, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3519.71, "standard_charge_percentage": 42.0000, "estimated_amount": 3519, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3447.14, "standard_charge_percentage": 42.0000, "estimated_amount": 3447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6911.55, "standard_charge_percentage": 80.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 4218.64, "standard_charge_percentage": 48.8300, "estimated_amount": 4218, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6911.55, "standard_charge_percentage": 80.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7083.79, "discounted_cash": 10131,"minimum": 1287,"maximum": 7083.79,"payers_information":[{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6198.32, "standard_charge_percentage": 87.5000, "estimated_amount": 6198, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5854, "estimated_amount": 5854, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4958.65, "standard_charge_percentage": 70.0000, "estimated_amount": 4958, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2885.94, "standard_charge_percentage": 42.0000, "estimated_amount": 2885, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1287, "estimated_amount": 1287, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2125.14, "standard_charge_percentage": 30.0000, "estimated_amount": 2125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3459.01, "standard_charge_percentage": 48.8300, "estimated_amount": 3459, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2975.19, "standard_charge_percentage": 42.0000, "estimated_amount": 2975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5312.84, "standard_charge_percentage": 75.0000, "estimated_amount": 5312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5667.03, "standard_charge_percentage": 80.0000, "estimated_amount": 5667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5667.03, "standard_charge_percentage": 80.0000, "estimated_amount": 5667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6375.41, "standard_charge_percentage": 90.0000, "estimated_amount": 6375, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4540.39, "estimated_amount": 4540, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3541.89, "standard_charge_percentage": 50.0000, "estimated_amount": 3541, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2826.43, "standard_charge_percentage": 42.0000, "estimated_amount": 2826, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5667.03, "standard_charge_percentage": 80.0000, "estimated_amount": 5667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2808.22, "estimated_amount": 2808, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2885.94, "standard_charge_percentage": 42.0000, "estimated_amount": 2885, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5667.03, "standard_charge_percentage": 80.0000, "estimated_amount": 5667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5667.03, "standard_charge_percentage": 80.0000, "estimated_amount": 5667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5667.03, "standard_charge_percentage": 80.0000, "estimated_amount": 5667, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5667.03, "standard_charge_percentage": 80.0000, "estimated_amount": 5667, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5667.03, "standard_charge_percentage": 80.0000, "estimated_amount": 5667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2826.43, "standard_charge_percentage": 42.0000, "estimated_amount": 2826, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2885.94, "standard_charge_percentage": 42.0000, "estimated_amount": 2885, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 6928.44, "estimated_amount": 6928, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2808.22, "estimated_amount": 2808, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5667.03, "standard_charge_percentage": 80.0000, "estimated_amount": 5667, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2945.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2945, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5667.03, "standard_charge_percentage": 80.0000, "estimated_amount": 5667, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6375.41, "standard_charge_percentage": 90.0000, "estimated_amount": 6375, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4250.27, "standard_charge_percentage": 60.0000, "estimated_amount": 4250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6021.22, "standard_charge_percentage": 85.0000, "estimated_amount": 6021, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2885.94, "standard_charge_percentage": 42.0000, "estimated_amount": 2885, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6729.6, "standard_charge_percentage": 95.0000, "estimated_amount": 6729, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2695.59, "estimated_amount": 2695, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4958.65, "standard_charge_percentage": 70.0000, "estimated_amount": 4958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4958.65, "standard_charge_percentage": 70.0000, "estimated_amount": 4958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2975.19, "standard_charge_percentage": 42.0000, "estimated_amount": 2975, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6375.41, "standard_charge_percentage": 90.0000, "estimated_amount": 6375, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 7083.79, "estimated_amount": 7083, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20936", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8758.92,"minimum": 256.43,"maximum": 8320.97,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 6569.19, "standard_charge_percentage": 75.0000, "estimated_amount": 6569, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6131.24, "standard_charge_percentage": 70.0000, "estimated_amount": 6131, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 7007.14, "standard_charge_percentage": 80.0000, "estimated_amount": 7007, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7883.03, "standard_charge_percentage": 90.0000, "estimated_amount": 7883, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5854, "estimated_amount": 5854, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3494.81, "standard_charge_percentage": 42.0000, "estimated_amount": 3494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2627.68, "standard_charge_percentage": 30.0000, "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7883.03, "standard_charge_percentage": 90.0000, "estimated_amount": 7883, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 7007.14, "standard_charge_percentage": 80.0000, "estimated_amount": 7007, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3678.75, "standard_charge_percentage": 42.0000, "estimated_amount": 3678, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6131.24, "standard_charge_percentage": 70.0000, "estimated_amount": 6131, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3568.38, "standard_charge_percentage": 42.0000, "estimated_amount": 3568, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3568.38, "standard_charge_percentage": 42.0000, "estimated_amount": 3568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3494.81, "standard_charge_percentage": 42.0000, "estimated_amount": 3494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7007.14, "standard_charge_percentage": 80.0000, "estimated_amount": 7007, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3568.38, "standard_charge_percentage": 42.0000, "estimated_amount": 3568, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 7007.14, "standard_charge_percentage": 80.0000, "estimated_amount": 7007, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 7445.08, "standard_charge_percentage": 85.0000, "estimated_amount": 7445, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6131.24, "standard_charge_percentage": 70.0000, "estimated_amount": 6131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 7007.14, "standard_charge_percentage": 80.0000, "estimated_amount": 7007, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 7007.14, "standard_charge_percentage": 80.0000, "estimated_amount": 7007, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 8320.97, "standard_charge_percentage": 95.0000, "estimated_amount": 8320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5255.35, "standard_charge_percentage": 60.0000, "estimated_amount": 5255, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 256.43, "estimated_amount": 256, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 7007.14, "standard_charge_percentage": 80.0000, "estimated_amount": 7007, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7007.14, "standard_charge_percentage": 80.0000, "estimated_amount": 7007, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 7664.06, "standard_charge_percentage": 87.5000, "estimated_amount": 7664, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 7007.14, "standard_charge_percentage": 80.0000, "estimated_amount": 7007, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3678.75, "standard_charge_percentage": 42.0000, "estimated_amount": 3678, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7883.03, "standard_charge_percentage": 90.0000, "estimated_amount": 7883, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3641.96, "standard_charge_percentage": 42.0000, "estimated_amount": 3641, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3568.38, "standard_charge_percentage": 42.0000, "estimated_amount": 3568, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4379.46, "standard_charge_percentage": 50.0000, "estimated_amount": 4379, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1287, "estimated_amount": 1287, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 7007.14, "standard_charge_percentage": 80.0000, "estimated_amount": 7007, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7738.76,"minimum": 519.96,"maximum": 7351.82,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2321.63, "standard_charge_percentage": 30.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3087.77, "standard_charge_percentage": 42.0000, "estimated_amount": 3087, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5804.07, "standard_charge_percentage": 75.0000, "estimated_amount": 5804, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5854, "estimated_amount": 5854, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6191.01, "standard_charge_percentage": 80.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6191.01, "standard_charge_percentage": 80.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6191.01, "standard_charge_percentage": 80.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6577.95, "standard_charge_percentage": 85.0000, "estimated_amount": 6577, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3217.78, "standard_charge_percentage": 42.0000, "estimated_amount": 3217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6191.01, "standard_charge_percentage": 80.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3152.77, "standard_charge_percentage": 42.0000, "estimated_amount": 3152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7351.82, "standard_charge_percentage": 95.0000, "estimated_amount": 7351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5417.13, "standard_charge_percentage": 70.0000, "estimated_amount": 5417, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6964.88, "standard_charge_percentage": 90.0000, "estimated_amount": 6964, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6771.41, "standard_charge_percentage": 87.5000, "estimated_amount": 6771, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3152.77, "standard_charge_percentage": 42.0000, "estimated_amount": 3152, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6964.88, "standard_charge_percentage": 90.0000, "estimated_amount": 6964, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6191.01, "standard_charge_percentage": 80.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3250.28, "standard_charge_percentage": 42.0000, "estimated_amount": 3250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3152.77, "standard_charge_percentage": 42.0000, "estimated_amount": 3152, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6191.01, "standard_charge_percentage": 80.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3087.77, "standard_charge_percentage": 42.0000, "estimated_amount": 3087, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3152.77, "standard_charge_percentage": 42.0000, "estimated_amount": 3152, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1287, "estimated_amount": 1287, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6191.01, "standard_charge_percentage": 80.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4643.26, "standard_charge_percentage": 60.0000, "estimated_amount": 4643, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5417.13, "standard_charge_percentage": 70.0000, "estimated_amount": 5417, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6964.88, "standard_charge_percentage": 90.0000, "estimated_amount": 6964, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5417.13, "standard_charge_percentage": 70.0000, "estimated_amount": 5417, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3869.38, "standard_charge_percentage": 50.0000, "estimated_amount": 3869, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3250.28, "standard_charge_percentage": 42.0000, "estimated_amount": 3250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6191.01, "standard_charge_percentage": 80.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6191.01, "standard_charge_percentage": 80.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6191.01, "standard_charge_percentage": 80.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Radiorequency Bone Tumor Ablation, Perq", "code_information": [ { "code": "20982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11978, "discounted_cash": 18248,"minimum": 1045.33,"maximum": 11978,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4879.84, "standard_charge_percentage": 42.0000, "estimated_amount": 4879, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 8983.5, "standard_charge_percentage": 75.0000, "estimated_amount": 8983, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 4262.21, "estimated_amount": 4262, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 10480.8, "standard_charge_percentage": 87.5000, "estimated_amount": 10480, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4879.84, "standard_charge_percentage": 42.0000, "estimated_amount": 4879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5989, "standard_charge_percentage": 50.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 4779.22, "standard_charge_percentage": 42.0000, "estimated_amount": 4779, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4980.45, "standard_charge_percentage": 42.0000, "estimated_amount": 4980, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5848.86, "standard_charge_percentage": 48.8300, "estimated_amount": 5848, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 5030.76, "standard_charge_percentage": 42.0000, "estimated_amount": 5030, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 5030.76, "standard_charge_percentage": 42.0000, "estimated_amount": 5030, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 11379.1, "standard_charge_percentage": 95.0000, "estimated_amount": 11379, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 10181.3, "standard_charge_percentage": 85.0000, "estimated_amount": 10181, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4540.39, "estimated_amount": 4540, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4879.84, "standard_charge_percentage": 42.0000, "estimated_amount": 4879, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7186.8, "standard_charge_percentage": 60.0000, "estimated_amount": 7186, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 4262.21, "estimated_amount": 4262, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1329, "estimated_amount": 1329, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4879.84, "standard_charge_percentage": 42.0000, "estimated_amount": 4879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3593.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3593, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 4779.22, "standard_charge_percentage": 42.0000, "estimated_amount": 4779, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2695.59, "estimated_amount": 2695, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5979, "estimated_amount": 5979, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 11978, "estimated_amount": 11978, "methodology": "fee schedule" }]}]} , { "description": "Hc Ablation Bone Tumor W/ Img Gdn When Prfmd", "code_information": [ { "code": "20983", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11978, "discounted_cash": 10131,"minimum": 1383,"maximum": 11379.1,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7186.8, "standard_charge_percentage": 60.0000, "estimated_amount": 7186, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1383, "estimated_amount": 1383, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 8983.5, "standard_charge_percentage": 75.0000, "estimated_amount": 8983, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 4633.95, "estimated_amount": 4633, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 5989, "standard_charge_percentage": 50.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10910.9, "estimated_amount": 10910, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4879.84, "standard_charge_percentage": 42.0000, "estimated_amount": 4879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4879.84, "standard_charge_percentage": 42.0000, "estimated_amount": 4879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 6928.44, "estimated_amount": 6928, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 4779.22, "standard_charge_percentage": 42.0000, "estimated_amount": 4779, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 10181.3, "standard_charge_percentage": 85.0000, "estimated_amount": 10181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5848.86, "standard_charge_percentage": 48.8300, "estimated_amount": 5848, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 7805.32, "estimated_amount": 7805, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 4767.76, "estimated_amount": 4767, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5989, "standard_charge_percentage": 50.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 11379.1, "standard_charge_percentage": 95.0000, "estimated_amount": 11379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4980.45, "standard_charge_percentage": 42.0000, "estimated_amount": 4980, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4879.84, "standard_charge_percentage": 42.0000, "estimated_amount": 4879, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6315, "estimated_amount": 6315, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 4767.76, "estimated_amount": 4767, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 10480.8, "standard_charge_percentage": 87.5000, "estimated_amount": 10480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 4779.22, "standard_charge_percentage": 42.0000, "estimated_amount": 4779, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4879.84, "standard_charge_percentage": 42.0000, "estimated_amount": 4879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3593.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 8183.2, "estimated_amount": 8183, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 5030.76, "standard_charge_percentage": 42.0000, "estimated_amount": 5030, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 5030.76, "standard_charge_percentage": 42.0000, "estimated_amount": 5030, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc Face Les Sc <2 Cm", "code_information": [ { "code": "21011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2297,"minimum": 519.96,"maximum": 6234.38,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 770.88, "estimated_amount": 770, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 770.88, "estimated_amount": 770, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" }]}]} , { "description": "Exc face les sbq 2 cm/>", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7037.5, "discounted_cash": 2297,"minimum": 519.96,"maximum": 6685.63,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2807.96, "standard_charge_percentage": 42.0000, "estimated_amount": 2807, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5981.88, "standard_charge_percentage": 85.0000, "estimated_amount": 5981, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4926.25, "standard_charge_percentage": 70.0000, "estimated_amount": 4926, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2926.19, "standard_charge_percentage": 42.0000, "estimated_amount": 2926, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6333.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6333, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5278.13, "standard_charge_percentage": 75.0000, "estimated_amount": 5278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2807.96, "standard_charge_percentage": 42.0000, "estimated_amount": 2807, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6685.63, "standard_charge_percentage": 95.0000, "estimated_amount": 6685, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5630, "standard_charge_percentage": 80.0000, "estimated_amount": 5630, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5630, "standard_charge_percentage": 80.0000, "estimated_amount": 5630, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2867.08, "standard_charge_percentage": 42.0000, "estimated_amount": 2867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 770.88, "estimated_amount": 770, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6157.81, "standard_charge_percentage": 87.5000, "estimated_amount": 6157, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2955.75, "standard_charge_percentage": 42.0000, "estimated_amount": 2955, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5630, "standard_charge_percentage": 80.0000, "estimated_amount": 5630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3518.75, "standard_charge_percentage": 50.0000, "estimated_amount": 3518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5630, "standard_charge_percentage": 80.0000, "estimated_amount": 5630, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2867.08, "standard_charge_percentage": 42.0000, "estimated_amount": 2867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2867.08, "standard_charge_percentage": 42.0000, "estimated_amount": 2867, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6333.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6333, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5630, "standard_charge_percentage": 80.0000, "estimated_amount": 5630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2955.75, "standard_charge_percentage": 42.0000, "estimated_amount": 2955, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4926.25, "standard_charge_percentage": 70.0000, "estimated_amount": 4926, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5630, "standard_charge_percentage": 80.0000, "estimated_amount": 5630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 770.88, "estimated_amount": 770, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3436.41, "standard_charge_percentage": 48.8300, "estimated_amount": 3436, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5630, "standard_charge_percentage": 80.0000, "estimated_amount": 5630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2111.25, "standard_charge_percentage": 30.0000, "estimated_amount": 2111, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6333.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6333, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4222.5, "standard_charge_percentage": 60.0000, "estimated_amount": 4222, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5630, "standard_charge_percentage": 80.0000, "estimated_amount": 5630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2867.08, "standard_charge_percentage": 42.0000, "estimated_amount": 2867, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5630, "standard_charge_percentage": 80.0000, "estimated_amount": 5630, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4926.25, "standard_charge_percentage": 70.0000, "estimated_amount": 4926, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5630, "standard_charge_percentage": 80.0000, "estimated_amount": 5630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" }]}]} , { "description": "CLOSED TX NOSE FX WO STABLJ", "code_information": [ { "code": "21315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8084.5, "discounted_cash": 2100,"minimum": 519.96,"maximum": 7680.27,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1696.81, "estimated_amount": 1696, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1722.67, "estimated_amount": 1722, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 7073.94, "standard_charge_percentage": 87.5000, "estimated_amount": 7073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2262.41, "estimated_amount": 2262, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1620.22, "estimated_amount": 1620, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1612.86, "standard_charge_percentage": 21.0000, "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7680.27, "standard_charge_percentage": 95.0000, "estimated_amount": 7680, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4042.25, "standard_charge_percentage": 50.0000, "estimated_amount": 4042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3947.66, "standard_charge_percentage": 48.8300, "estimated_amount": 3947, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1648.33, "estimated_amount": 1648, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1620.22, "estimated_amount": 1620, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1697.74, "standard_charge_percentage": 21.0000, "estimated_amount": 1697, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4850.7, "standard_charge_percentage": 60.0000, "estimated_amount": 4850, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6871.82, "standard_charge_percentage": 85.0000, "estimated_amount": 6871, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1819.38, "estimated_amount": 1819, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 6063.38, "standard_charge_percentage": 75.0000, "estimated_amount": 6063, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1697.74, "standard_charge_percentage": 21.0000, "estimated_amount": 1697, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2425.35, "standard_charge_percentage": 30.0000, "estimated_amount": 2425, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1680.77, "standard_charge_percentage": 21.0000, "estimated_amount": 1680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1612.86, "standard_charge_percentage": 21.0000, "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1648.33, "estimated_amount": 1648, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1436.63, "estimated_amount": 1436, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 3064.53, "estimated_amount": 3064, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Nose Fx W Stabil", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8084.5, "discounted_cash": 4599,"minimum": 1045.33,"maximum": 7680.27,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1612.86, "standard_charge_percentage": 21.0000, "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4042.25, "standard_charge_percentage": 50.0000, "estimated_amount": 4042, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 6063.38, "standard_charge_percentage": 75.0000, "estimated_amount": 6063, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1680.77, "standard_charge_percentage": 21.0000, "estimated_amount": 1680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3608.81, "estimated_amount": 3608, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3145.33, "estimated_amount": 3145, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4850.7, "standard_charge_percentage": 60.0000, "estimated_amount": 4850, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3947.66, "standard_charge_percentage": 48.8300, "estimated_amount": 3947, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1620.22, "estimated_amount": 1620, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1697.74, "standard_charge_percentage": 21.0000, "estimated_amount": 1697, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3714.95, "estimated_amount": 3714, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1620.22, "estimated_amount": 1620, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1819.38, "estimated_amount": 1819, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3771.56, "estimated_amount": 3771, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3608.81, "estimated_amount": 3608, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7680.27, "standard_charge_percentage": 95.0000, "estimated_amount": 7680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1612.86, "standard_charge_percentage": 21.0000, "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6871.82, "standard_charge_percentage": 85.0000, "estimated_amount": 6871, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4953.27, "estimated_amount": 4953, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 7073.94, "standard_charge_percentage": 87.5000, "estimated_amount": 7073, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2425.35, "standard_charge_percentage": 30.0000, "estimated_amount": 2425, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 3064.53, "estimated_amount": 3064, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1697.74, "standard_charge_percentage": 21.0000, "estimated_amount": 1697, "methodology": "percent of total billed charges" }]}]} , { "description": "CLOSED TX SEPTAL&NOSE FX", "code_information": [ { "code": "21337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8084.5, "discounted_cash": 4599,"minimum": 1045.33,"maximum": 7680.27,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3145.33, "estimated_amount": 3145, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4953.27, "estimated_amount": 4953, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1819.38, "estimated_amount": 1819, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2425.35, "standard_charge_percentage": 30.0000, "estimated_amount": 2425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3608.81, "estimated_amount": 3608, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3608.81, "estimated_amount": 3608, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1612.86, "standard_charge_percentage": 21.0000, "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3714.95, "estimated_amount": 3714, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4850.7, "standard_charge_percentage": 60.0000, "estimated_amount": 4850, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1697.74, "standard_charge_percentage": 21.0000, "estimated_amount": 1697, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3947.66, "standard_charge_percentage": 48.8300, "estimated_amount": 3947, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1620.22, "estimated_amount": 1620, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6871.82, "standard_charge_percentage": 85.0000, "estimated_amount": 6871, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4042.25, "standard_charge_percentage": 50.0000, "estimated_amount": 4042, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 6063.38, "standard_charge_percentage": 75.0000, "estimated_amount": 6063, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1697.74, "standard_charge_percentage": 21.0000, "estimated_amount": 1697, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 3064.53, "estimated_amount": 3064, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3771.56, "estimated_amount": 3771, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7680.27, "standard_charge_percentage": 95.0000, "estimated_amount": 7680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1620.22, "estimated_amount": 1620, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1680.77, "standard_charge_percentage": 21.0000, "estimated_amount": 1680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1612.86, "standard_charge_percentage": 21.0000, "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 7073.94, "standard_charge_percentage": 87.5000, "estimated_amount": 7073, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Nose/Jaw Fracw Dent Wires Fix", "code_information": [ { "code": "21345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3448.15, "discounted_cash": 2100,"minimum": 687.91,"maximum": 3448.15,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 2998, "estimated_amount": 2998, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1722.67, "estimated_amount": 1722, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2586.11, "standard_charge_percentage": 75.0000, "estimated_amount": 2586, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3448.15, "estimated_amount": 3448, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 3017.13, "standard_charge_percentage": 87.5000, "estimated_amount": 3017, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3275.74, "standard_charge_percentage": 95.0000, "estimated_amount": 3275, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3448.15, "estimated_amount": 3448, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2262.41, "estimated_amount": 2262, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 716.87, "standard_charge_percentage": 21.0000, "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1683.73, "standard_charge_percentage": 48.8300, "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 724.11, "standard_charge_percentage": 21.0000, "estimated_amount": 724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2326.49, "estimated_amount": 2326, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1648.33, "estimated_amount": 1648, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 724.11, "standard_charge_percentage": 21.0000, "estimated_amount": 724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 687.91, "standard_charge_percentage": 21.0000, "estimated_amount": 687, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 687.91, "standard_charge_percentage": 21.0000, "estimated_amount": 687, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1696.81, "estimated_amount": 1696, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 2272.38, "estimated_amount": 2272, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1034.44, "standard_charge_percentage": 30.0000, "estimated_amount": 1034, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1436.63, "estimated_amount": 1436, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1307.06, "estimated_amount": 1307, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2068.89, "standard_charge_percentage": 60.0000, "estimated_amount": 2068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1648.33, "estimated_amount": 1648, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1724.08, "standard_charge_percentage": 50.0000, "estimated_amount": 1724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2326.49, "estimated_amount": 2326, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 775.99, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2930.93, "standard_charge_percentage": 85.0000, "estimated_amount": 2930, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Fx Orbit Wo Manip", "code_information": [ { "code": "21400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3448.15, "discounted_cash": 722,"minimum": 282,"maximum": 3448.15,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 724.11, "standard_charge_percentage": 21.0000, "estimated_amount": 724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 724.11, "standard_charge_percentage": 21.0000, "estimated_amount": 724, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 687.91, "standard_charge_percentage": 21.0000, "estimated_amount": 687, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 777.8, "estimated_amount": 777, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3275.74, "standard_charge_percentage": 95.0000, "estimated_amount": 3275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 592.24, "estimated_amount": 592, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2930.93, "standard_charge_percentage": 85.0000, "estimated_amount": 2930, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3448.15, "estimated_amount": 3448, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 775.99, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 707.93, "estimated_amount": 707, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 687.91, "standard_charge_percentage": 21.0000, "estimated_amount": 687, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 493.9, "estimated_amount": 493, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 566.68, "estimated_amount": 566, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2068.89, "standard_charge_percentage": 60.0000, "estimated_amount": 2068, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 3017.13, "standard_charge_percentage": 87.5000, "estimated_amount": 3017, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1307.06, "estimated_amount": 1307, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1683.73, "standard_charge_percentage": 48.8300, "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2586.11, "standard_charge_percentage": 75.0000, "estimated_amount": 2586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1034.44, "standard_charge_percentage": 30.0000, "estimated_amount": 1034, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1724.08, "standard_charge_percentage": 50.0000, "estimated_amount": 1724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 716.87, "standard_charge_percentage": 21.0000, "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 566.68, "estimated_amount": 566, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 583.35, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 707.93, "estimated_amount": 707, "methodology": "fee schedule" }]}]} , { "description": "CLOSED TX ORBIT W MANIPULJ", "code_information": [ { "code": "21401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3448.15, "discounted_cash": 2100,"minimum": 687.91,"maximum": 3448.15,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1722.67, "estimated_amount": 1722, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 724.11, "standard_charge_percentage": 21.0000, "estimated_amount": 724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 687.91, "standard_charge_percentage": 21.0000, "estimated_amount": 687, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2262.41, "estimated_amount": 2262, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3448.15, "estimated_amount": 3448, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 775.99, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2068.89, "standard_charge_percentage": 60.0000, "estimated_amount": 2068, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1620.22, "estimated_amount": 1620, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1436.63, "estimated_amount": 1436, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1683.73, "standard_charge_percentage": 48.8300, "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 3017.13, "standard_charge_percentage": 87.5000, "estimated_amount": 3017, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1307.06, "estimated_amount": 1307, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2930.93, "standard_charge_percentage": 85.0000, "estimated_amount": 2930, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 716.87, "standard_charge_percentage": 21.0000, "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3275.74, "standard_charge_percentage": 95.0000, "estimated_amount": 3275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 687.91, "standard_charge_percentage": 21.0000, "estimated_amount": 687, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1648.33, "estimated_amount": 1648, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2586.11, "standard_charge_percentage": 75.0000, "estimated_amount": 2586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1648.33, "estimated_amount": 1648, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1724.08, "standard_charge_percentage": 50.0000, "estimated_amount": 1724, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1620.22, "estimated_amount": 1620, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1696.81, "estimated_amount": 1696, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 724.11, "standard_charge_percentage": 21.0000, "estimated_amount": 724, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1034.44, "standard_charge_percentage": 30.0000, "estimated_amount": 1034, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Leforte I+Wires", "code_information": [ { "code": "21421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19779.9, "discounted_cash": 4599,"minimum": 1216,"maximum": 18790.9,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3946.09, "standard_charge_percentage": 21.0000, "estimated_amount": 3946, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5933.97, "standard_charge_percentage": 30.0000, "estimated_amount": 5933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 17801.9, "standard_charge_percentage": 90.0000, "estimated_amount": 17801, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3608.81, "estimated_amount": 3608, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 4451.37, "estimated_amount": 4451, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4029.17, "standard_charge_percentage": 21.0000, "estimated_amount": 4029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 9889.95, "standard_charge_percentage": 50.0000, "estimated_amount": 9889, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 7497.8, "estimated_amount": 7497, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4153.78, "standard_charge_percentage": 21.0000, "estimated_amount": 4153, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4153.78, "standard_charge_percentage": 21.0000, "estimated_amount": 4153, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 17307.4, "standard_charge_percentage": 87.5000, "estimated_amount": 17307, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 18790.9, "standard_charge_percentage": 95.0000, "estimated_amount": 18790, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4029.17, "standard_charge_percentage": 21.0000, "estimated_amount": 4029, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 17801.9, "standard_charge_percentage": 90.0000, "estimated_amount": 17801, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4112.24, "standard_charge_percentage": 21.0000, "estimated_amount": 4112, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2326.49, "estimated_amount": 2326, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 13845.9, "standard_charge_percentage": 70.0000, "estimated_amount": 13845, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4029.17, "standard_charge_percentage": 21.0000, "estimated_amount": 4029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 14834.9, "standard_charge_percentage": 75.0000, "estimated_amount": 14834, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3946.09, "standard_charge_percentage": 21.0000, "estimated_amount": 3946, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2326.49, "estimated_amount": 2326, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3714.95, "estimated_amount": 3714, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 16812.9, "standard_charge_percentage": 85.0000, "estimated_amount": 16812, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 13845.9, "standard_charge_percentage": 70.0000, "estimated_amount": 13845, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 9658.53, "standard_charge_percentage": 48.8300, "estimated_amount": 9658, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3608.81, "estimated_amount": 3608, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 13845.9, "standard_charge_percentage": 70.0000, "estimated_amount": 13845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3771.56, "estimated_amount": 3771, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4953.27, "estimated_amount": 4953, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4029.17, "standard_charge_percentage": 21.0000, "estimated_amount": 4029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3145.33, "estimated_amount": 3145, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 17801.9, "standard_charge_percentage": 90.0000, "estimated_amount": 17801, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 11867.9, "standard_charge_percentage": 60.0000, "estimated_amount": 11867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Leforte Iii+Wires", "code_information": [ { "code": "21431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9731,"minimum": 1329,"maximum": 9244.45,"payers_information":[{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 7599.91, "estimated_amount": 7599, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6811.7, "standard_charge_percentage": 70.0000, "estimated_amount": 6811, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1941.33, "standard_charge_percentage": 21.0000, "estimated_amount": 1941, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 8757.9, "standard_charge_percentage": 90.0000, "estimated_amount": 8757, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1982.2, "standard_charge_percentage": 21.0000, "estimated_amount": 1982, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 8757.9, "standard_charge_percentage": 90.0000, "estimated_amount": 8757, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2023.07, "standard_charge_percentage": 21.0000, "estimated_amount": 2023, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 9244.45, "standard_charge_percentage": 95.0000, "estimated_amount": 9244, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4865.5, "standard_charge_percentage": 50.0000, "estimated_amount": 4865, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 2272.38, "estimated_amount": 2272, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2043.51, "standard_charge_percentage": 21.0000, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 8271.35, "standard_charge_percentage": 85.0000, "estimated_amount": 8271, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5979, "estimated_amount": 5979, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2919.3, "standard_charge_percentage": 30.0000, "estimated_amount": 2919, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1982.2, "standard_charge_percentage": 21.0000, "estimated_amount": 1982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7784.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7784, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 8514.63, "standard_charge_percentage": 87.5000, "estimated_amount": 8514, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 7784.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7784, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 7784.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7784, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 8771.07, "estimated_amount": 8771, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1982.2, "standard_charge_percentage": 21.0000, "estimated_amount": 1982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 7784.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7784, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 8757.9, "standard_charge_percentage": 90.0000, "estimated_amount": 8757, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 7784.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7784, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6811.7, "standard_charge_percentage": 70.0000, "estimated_amount": 6811, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 7784.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 4751.65, "standard_charge_percentage": 48.8300, "estimated_amount": 4751, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 4500.61, "estimated_amount": 4500, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1941.33, "standard_charge_percentage": 21.0000, "estimated_amount": 1941, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1329, "estimated_amount": 1329, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 7298.25, "standard_charge_percentage": 75.0000, "estimated_amount": 7298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7784.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7784, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1982.2, "standard_charge_percentage": 21.0000, "estimated_amount": 1982, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 7784.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6811.7, "standard_charge_percentage": 70.0000, "estimated_amount": 6811, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5838.6, "standard_charge_percentage": 60.0000, "estimated_amount": 5838, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2043.51, "standard_charge_percentage": 21.0000, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 7784.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7784, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 7784.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7784, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Dental Ridge Fx", "code_information": [ { "code": "21440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8084.5, "discounted_cash": 4599,"minimum": 1216,"maximum": 7680.27,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3145.33, "estimated_amount": 3145, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 7073.94, "standard_charge_percentage": 87.5000, "estimated_amount": 7073, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3714.95, "estimated_amount": 3714, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3771.56, "estimated_amount": 3771, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1819.38, "estimated_amount": 1819, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4850.7, "standard_charge_percentage": 60.0000, "estimated_amount": 4850, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4042.25, "standard_charge_percentage": 50.0000, "estimated_amount": 4042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 6063.38, "standard_charge_percentage": 75.0000, "estimated_amount": 6063, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4953.27, "estimated_amount": 4953, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2425.35, "standard_charge_percentage": 30.0000, "estimated_amount": 2425, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1680.77, "standard_charge_percentage": 21.0000, "estimated_amount": 1680, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3608.81, "estimated_amount": 3608, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2326.49, "estimated_amount": 2326, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1612.86, "standard_charge_percentage": 21.0000, "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1612.86, "standard_charge_percentage": 21.0000, "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7680.27, "standard_charge_percentage": 95.0000, "estimated_amount": 7680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1697.74, "standard_charge_percentage": 21.0000, "estimated_amount": 1697, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6871.82, "standard_charge_percentage": 85.0000, "estimated_amount": 6871, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3538.05, "estimated_amount": 3538, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1697.74, "standard_charge_percentage": 21.0000, "estimated_amount": 1697, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3947.66, "standard_charge_percentage": 48.8300, "estimated_amount": 3947, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 3064.53, "estimated_amount": 3064, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3608.81, "estimated_amount": 3608, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2326.49, "estimated_amount": 2326, "methodology": "case rate" }]}]} , { "description": "Hc Clsd Treat Mandible Fx Wo Manip", "code_information": [ { "code": "21450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1564.65, "discounted_cash": 722,"minimum": 282,"maximum": 1564.65,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1251.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1251, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 352.12, "estimated_amount": 352, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1408.18, "standard_charge_percentage": 90.0000, "estimated_amount": 1408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 493.9, "estimated_amount": 493, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 469.39, "standard_charge_percentage": 30.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1095.26, "standard_charge_percentage": 70.0000, "estimated_amount": 1095, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1251.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1251, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1251.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1251, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1095.26, "standard_charge_percentage": 70.0000, "estimated_amount": 1095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 583.35, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 310.78, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1251.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1251, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1251.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1173.49, "standard_charge_percentage": 75.0000, "estimated_amount": 1173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1095.26, "standard_charge_percentage": 70.0000, "estimated_amount": 1095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1251.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1251, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1408.18, "standard_charge_percentage": 90.0000, "estimated_amount": 1408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 312.15, "standard_charge_percentage": 21.0000, "estimated_amount": 312, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1369.07, "standard_charge_percentage": 87.5000, "estimated_amount": 1369, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1251.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1251, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1251.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1251, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1408.18, "standard_charge_percentage": 90.0000, "estimated_amount": 1408, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 318.72, "standard_charge_percentage": 21.0000, "estimated_amount": 318, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 318.72, "standard_charge_percentage": 21.0000, "estimated_amount": 318, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 325.29, "standard_charge_percentage": 21.0000, "estimated_amount": 325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 566.68, "estimated_amount": 566, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1564.65, "estimated_amount": 1564, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 777.8, "estimated_amount": 777, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1329.95, "standard_charge_percentage": 85.0000, "estimated_amount": 1329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 764.02, "standard_charge_percentage": 48.8300, "estimated_amount": 764, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1251.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 1564.65, "estimated_amount": 1564, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 938.79, "standard_charge_percentage": 60.0000, "estimated_amount": 938, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 318.72, "standard_charge_percentage": 21.0000, "estimated_amount": 318, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 328.58, "standard_charge_percentage": 21.0000, "estimated_amount": 328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 592.24, "estimated_amount": 592, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 318.72, "standard_charge_percentage": 21.0000, "estimated_amount": 318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1251.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1564.65, "estimated_amount": 1564, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 566.68, "estimated_amount": 566, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 593.1, "estimated_amount": 593, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1564.65, "estimated_amount": 1564, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1486.42, "standard_charge_percentage": 95.0000, "estimated_amount": 1486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 328.58, "standard_charge_percentage": 21.0000, "estimated_amount": 328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 312.15, "standard_charge_percentage": 21.0000, "estimated_amount": 312, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 782.33, "standard_charge_percentage": 50.0000, "estimated_amount": 782, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 310.78, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 555.57, "estimated_amount": 555, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Mandible Fx W Manip", "code_information": [ { "code": "21451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8084.5, "discounted_cash": 2100,"minimum": 707.93,"maximum": 7680.27,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 6063.38, "standard_charge_percentage": 75.0000, "estimated_amount": 6063, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1648.33, "estimated_amount": 1648, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1819.38, "estimated_amount": 1819, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4042.25, "standard_charge_percentage": 50.0000, "estimated_amount": 4042, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1612.86, "standard_charge_percentage": 21.0000, "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2262.41, "estimated_amount": 2262, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 7073.94, "standard_charge_percentage": 87.5000, "estimated_amount": 7073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3947.66, "standard_charge_percentage": 48.8300, "estimated_amount": 3947, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7680.27, "standard_charge_percentage": 95.0000, "estimated_amount": 7680, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1697.74, "standard_charge_percentage": 21.0000, "estimated_amount": 1697, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 3064.53, "estimated_amount": 3064, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1680.77, "standard_charge_percentage": 21.0000, "estimated_amount": 1680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6871.82, "standard_charge_percentage": 85.0000, "estimated_amount": 6871, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1646.81, "standard_charge_percentage": 21.0000, "estimated_amount": 1646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1697.74, "standard_charge_percentage": 21.0000, "estimated_amount": 1697, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 707.93, "estimated_amount": 707, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1612.86, "standard_charge_percentage": 21.0000, "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5659.15, "standard_charge_percentage": 70.0000, "estimated_amount": 5659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1436.63, "estimated_amount": 1436, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2425.35, "standard_charge_percentage": 30.0000, "estimated_amount": 2425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1722.67, "estimated_amount": 1722, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7276.05, "standard_charge_percentage": 90.0000, "estimated_amount": 7276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4850.7, "standard_charge_percentage": 60.0000, "estimated_amount": 4850, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1648.33, "estimated_amount": 1648, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1696.81, "estimated_amount": 1696, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 707.93, "estimated_amount": 707, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6467.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6467, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT LOWER JAW FRACTURE", "code_information": [ { "code": "21453", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19779.9, "discounted_cash": 8389,"minimum": 1329,"maximum": 18790.9,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 6879.69, "estimated_amount": 6879, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1329, "estimated_amount": 1329, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 14834.9, "standard_charge_percentage": 75.0000, "estimated_amount": 14834, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 13845.9, "standard_charge_percentage": 70.0000, "estimated_amount": 13845, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 7497.8, "estimated_amount": 7497, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 6453.74, "estimated_amount": 6453, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 6582.81, "estimated_amount": 6582, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 17801.9, "standard_charge_percentage": 90.0000, "estimated_amount": 17801, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 3935.25, "estimated_amount": 3935, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3946.09, "standard_charge_percentage": 21.0000, "estimated_amount": 3946, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 6453.74, "estimated_amount": 6453, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4153.78, "standard_charge_percentage": 21.0000, "estimated_amount": 4153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 3935.25, "estimated_amount": 3935, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 17801.9, "standard_charge_percentage": 90.0000, "estimated_amount": 17801, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 9658.53, "standard_charge_percentage": 48.8300, "estimated_amount": 9658, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 6453.74, "estimated_amount": 6453, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4112.24, "standard_charge_percentage": 21.0000, "estimated_amount": 4112, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6453.74, "estimated_amount": 6453, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 18790.9, "standard_charge_percentage": 95.0000, "estimated_amount": 18790, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 6453.74, "estimated_amount": 6453, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 6453.74, "estimated_amount": 6453, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 6776.43, "estimated_amount": 6776, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 17801.9, "standard_charge_percentage": 90.0000, "estimated_amount": 17801, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4029.17, "standard_charge_percentage": 21.0000, "estimated_amount": 4029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 11867.9, "standard_charge_percentage": 60.0000, "estimated_amount": 11867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 6582.81, "estimated_amount": 6582, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 17307.4, "standard_charge_percentage": 87.5000, "estimated_amount": 17307, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4029.17, "standard_charge_percentage": 21.0000, "estimated_amount": 4029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 6453.74, "estimated_amount": 6453, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 6453.74, "estimated_amount": 6453, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 16812.9, "standard_charge_percentage": 85.0000, "estimated_amount": 16812, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 5737.37, "estimated_amount": 5737, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 13845.9, "standard_charge_percentage": 70.0000, "estimated_amount": 13845, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 4451.37, "estimated_amount": 4451, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3946.09, "standard_charge_percentage": 21.0000, "estimated_amount": 3946, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4029.17, "standard_charge_percentage": 21.0000, "estimated_amount": 4029, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 6453.74, "estimated_amount": 6453, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6453.74, "estimated_amount": 6453, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 13845.9, "standard_charge_percentage": 70.0000, "estimated_amount": 13845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 9035.24, "estimated_amount": 9035, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5933.97, "standard_charge_percentage": 30.0000, "estimated_amount": 5933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4153.78, "standard_charge_percentage": 21.0000, "estimated_amount": 4153, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 9889.95, "standard_charge_percentage": 50.0000, "estimated_amount": 9889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6453.74, "estimated_amount": 6453, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15823.9, "standard_charge_percentage": 80.0000, "estimated_amount": 15823, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5979, "estimated_amount": 5979, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4029.17, "standard_charge_percentage": 21.0000, "estimated_amount": 4029, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Temporomandibl Disloc", "code_information": [ { "code": "21480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.45, "discounted_cash": 340,"minimum": 104.41,"maximum": 646.45,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 646.45, "estimated_amount": 646, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 517.16, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 387.87, "standard_charge_percentage": 60.0000, "estimated_amount": 387, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 517.16, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 517.16, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 646.45, "estimated_amount": 646, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 581.81, "standard_charge_percentage": 90.0000, "estimated_amount": 581, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 452.51, "standard_charge_percentage": 70.0000, "estimated_amount": 452, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 245.04, "estimated_amount": 245, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 517.16, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 315.66, "standard_charge_percentage": 48.8300, "estimated_amount": 315, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 452.51, "standard_charge_percentage": 70.0000, "estimated_amount": 452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 104.41, "estimated_amount": 104, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 581.81, "standard_charge_percentage": 90.0000, "estimated_amount": 581, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 131.68, "standard_charge_percentage": 21.0000, "estimated_amount": 131, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 517.16, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 517.16, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 135.75, "standard_charge_percentage": 21.0000, "estimated_amount": 135, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 131.68, "standard_charge_percentage": 21.0000, "estimated_amount": 131, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 565.64, "standard_charge_percentage": 87.5000, "estimated_amount": 565, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 517.16, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 517.16, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 646.45, "estimated_amount": 646, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 145.48, "estimated_amount": 145, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 193.94, "standard_charge_percentage": 30.0000, "estimated_amount": 193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 128.97, "standard_charge_percentage": 21.0000, "estimated_amount": 128, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 517.16, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 134.4, "standard_charge_percentage": 21.0000, "estimated_amount": 134, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 131.68, "standard_charge_percentage": 21.0000, "estimated_amount": 131, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 581.81, "standard_charge_percentage": 90.0000, "estimated_amount": 581, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 131.68, "standard_charge_percentage": 21.0000, "estimated_amount": 131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 128.97, "standard_charge_percentage": 21.0000, "estimated_amount": 128, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 549.48, "standard_charge_percentage": 85.0000, "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 452.51, "standard_charge_percentage": 70.0000, "estimated_amount": 452, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 135.75, "standard_charge_percentage": 21.0000, "estimated_amount": 135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 104.41, "estimated_amount": 104, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 517.16, "standard_charge_percentage": 80.0000, "estimated_amount": 517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 323.23, "standard_charge_percentage": 50.0000, "estimated_amount": 323, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 614.13, "standard_charge_percentage": 95.0000, "estimated_amount": 614, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 484.84, "standard_charge_percentage": 75.0000, "estimated_amount": 484, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Temporomandibl Disloc Complic", "code_information": [ { "code": "21485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3448.15, "discounted_cash": 2100,"minimum": 687.91,"maximum": 3448.15,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 775.99, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2930.93, "standard_charge_percentage": 85.0000, "estimated_amount": 2930, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1648.33, "estimated_amount": 1648, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2262.41, "estimated_amount": 2262, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1034.44, "standard_charge_percentage": 30.0000, "estimated_amount": 1034, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1307.06, "estimated_amount": 1307, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2068.89, "standard_charge_percentage": 60.0000, "estimated_amount": 2068, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1696.81, "estimated_amount": 1696, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1436.63, "estimated_amount": 1436, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1724.08, "standard_charge_percentage": 50.0000, "estimated_amount": 1724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 687.91, "standard_charge_percentage": 21.0000, "estimated_amount": 687, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3275.74, "standard_charge_percentage": 95.0000, "estimated_amount": 3275, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 3103.34, "standard_charge_percentage": 90.0000, "estimated_amount": 3103, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 3017.13, "standard_charge_percentage": 87.5000, "estimated_amount": 3017, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 716.87, "standard_charge_percentage": 21.0000, "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1620.22, "estimated_amount": 1620, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1648.33, "estimated_amount": 1648, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2758.52, "standard_charge_percentage": 80.0000, "estimated_amount": 2758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1620.22, "estimated_amount": 1620, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1683.73, "standard_charge_percentage": 48.8300, "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2413.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2586.11, "standard_charge_percentage": 75.0000, "estimated_amount": 2586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1722.67, "estimated_amount": 1722, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3448.15, "estimated_amount": 3448, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 724.11, "standard_charge_percentage": 21.0000, "estimated_amount": 724, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 724.11, "standard_charge_percentage": 21.0000, "estimated_amount": 724, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 702.39, "standard_charge_percentage": 21.0000, "estimated_amount": 702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1616.01, "estimated_amount": 1616, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 687.91, "standard_charge_percentage": 21.0000, "estimated_amount": 687, "methodology": "percent of total billed charges" }]}]} , { "description": "DRAIN NECKCHEST LESION", "code_information": [ { "code": "21501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1821.98, "estimated_amount": 1821, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1821.98, "estimated_amount": 1821, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1821.98, "estimated_amount": 1821, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1821.98, "estimated_amount": 1821, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" }]}]} , { "description": "Hc Biopsy Soft Tissue Neck/Chest", "code_information": [ { "code": "21550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 4709.9,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4709.9, "estimated_amount": 4709, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" }]}]} , { "description": "EXC NECK LES SC 3 CM>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 4059,"minimum": 1216,"maximum": 6234.38,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc neck les sc < 3 cm", "code_information": [ { "code": "21555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6234.38,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" }]}]} , { "description": "EXC NECK TUM DEEP < 5 CM", "code_information": [ { "code": "21556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6234.38,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT STERNUM FRACTURE", "code_information": [ { "code": "21820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 861.65, "discounted_cash": 340,"minimum": 150.15,"maximum": 861.65,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 179.14, "standard_charge_percentage": 21.0000, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 258.5, "standard_charge_percentage": 30.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 818.57, "standard_charge_percentage": 95.0000, "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 420.74, "standard_charge_percentage": 48.8300, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 753.94, "standard_charge_percentage": 87.5000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 732.4, "standard_charge_percentage": 85.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 516.99, "standard_charge_percentage": 60.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 646.24, "standard_charge_percentage": 75.0000, "estimated_amount": 646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 430.82, "standard_charge_percentage": 50.0000, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" }]}]} , { "description": "Hc Biopsy Soft Tissue Back,Superf", "code_information": [ { "code": "21920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 4474.4,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Biopsy Soft Tissue Back,Deep", "code_information": [ { "code": "21925", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" }]}]} , { "description": "Exc Back Les Sc < 3 Cm", "code_information": [ { "code": "21930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6234.38,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc back les sc 3 cm/>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7069.17, "discounted_cash": 2297,"minimum": 1216,"maximum": 6715.71,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5655.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5655, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6008.79, "standard_charge_percentage": 85.0000, "estimated_amount": 6008, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2879.98, "standard_charge_percentage": 42.0000, "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6362.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5655.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4948.42, "standard_charge_percentage": 70.0000, "estimated_amount": 4948, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4948.42, "standard_charge_percentage": 70.0000, "estimated_amount": 4948, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5655.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5655.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5655, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6715.71, "standard_charge_percentage": 95.0000, "estimated_amount": 6715, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6362.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2120.75, "standard_charge_percentage": 30.0000, "estimated_amount": 2120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.05, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5655.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2820.6, "standard_charge_percentage": 42.0000, "estimated_amount": 2820, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5655.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5655, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2879.98, "standard_charge_percentage": 42.0000, "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3451.88, "standard_charge_percentage": 48.8300, "estimated_amount": 3451, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5655.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2939.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2939, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2879.98, "standard_charge_percentage": 42.0000, "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5655.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5655, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5655.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5655, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6362.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6362, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6185.52, "standard_charge_percentage": 87.5000, "estimated_amount": 6185, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.05, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2879.98, "standard_charge_percentage": 42.0000, "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5301.88, "standard_charge_percentage": 75.0000, "estimated_amount": 5301, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5655.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5655, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3534.59, "standard_charge_percentage": 50.0000, "estimated_amount": 3534, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4948.42, "standard_charge_percentage": 70.0000, "estimated_amount": 4948, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4241.5, "standard_charge_percentage": 60.0000, "estimated_amount": 4241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2820.6, "standard_charge_percentage": 42.0000, "estimated_amount": 2820, "methodology": "percent of total billed charges" }]}]} , { "description": "EXC BACK TUM DEEP < 5 CM", "code_information": [ { "code": "21932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6234.38,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1644.38, "estimated_amount": 1644, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1644.38, "estimated_amount": 1644, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" }]}]} , { "description": "Exc Back Tum Deep 5 Cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6879.17, "discounted_cash": 4059,"minimum": 1216,"maximum": 6535.21,"payers_information":[{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4815.42, "standard_charge_percentage": 70.0000, "estimated_amount": 4815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2744.79, "standard_charge_percentage": 42.0000, "estimated_amount": 2744, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2063.75, "standard_charge_percentage": 30.0000, "estimated_amount": 2063, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5159.38, "standard_charge_percentage": 75.0000, "estimated_amount": 5159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2889.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4815.42, "standard_charge_percentage": 70.0000, "estimated_amount": 4815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6535.21, "standard_charge_percentage": 95.0000, "estimated_amount": 6535, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2802.57, "standard_charge_percentage": 42.0000, "estimated_amount": 2802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6191.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2889.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5847.29, "standard_charge_percentage": 85.0000, "estimated_amount": 5847, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6191.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6191.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2802.57, "standard_charge_percentage": 42.0000, "estimated_amount": 2802, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2860.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2860, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2802.57, "standard_charge_percentage": 42.0000, "estimated_amount": 2802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4127.5, "standard_charge_percentage": 60.0000, "estimated_amount": 4127, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4815.42, "standard_charge_percentage": 70.0000, "estimated_amount": 4815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3439.59, "standard_charge_percentage": 50.0000, "estimated_amount": 3439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2802.57, "standard_charge_percentage": 42.0000, "estimated_amount": 2802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2744.79, "standard_charge_percentage": 42.0000, "estimated_amount": 2744, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6019.27, "standard_charge_percentage": 87.5000, "estimated_amount": 6019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3359.1, "standard_charge_percentage": 48.8300, "estimated_amount": 3359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" }]}]} , { "description": "Hc Clsd Treat Vert Body Fract Wo Manip W Cast", "code_information": [ { "code": "22310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1187.5, "discounted_cash": 340,"minimum": 232.64,"maximum": 1187.5,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 593.75, "standard_charge_percentage": 50.0000, "estimated_amount": 593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 712.5, "standard_charge_percentage": 60.0000, "estimated_amount": 712, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 890.63, "standard_charge_percentage": 75.0000, "estimated_amount": 890, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 356.25, "standard_charge_percentage": 30.0000, "estimated_amount": 356, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 579.86, "standard_charge_percentage": 48.8300, "estimated_amount": 579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 267.24, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1039.06, "standard_charge_percentage": 87.5000, "estimated_amount": 1039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1128.13, "standard_charge_percentage": 95.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1187.5, "estimated_amount": 1187, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 246.88, "standard_charge_percentage": 21.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1009.38, "standard_charge_percentage": 85.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 450.13, "estimated_amount": 450, "methodology": "case rate" }]}]} , { "description": "Hc Clsd Treat Vert Body Fx W Manip", "code_information": [ { "code": "22315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 4601,"minimum": 1045.33,"maximum": 5482.25,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3610.52, "estimated_amount": 3610, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1867.57, "estimated_amount": 1867, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3610.52, "estimated_amount": 3610, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3773.35, "estimated_amount": 3773, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4955.62, "estimated_amount": 4955, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3146.82, "estimated_amount": 3146, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3716.72, "estimated_amount": 3716, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5482.25, "estimated_amount": 5482, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1867.57, "estimated_amount": 1867, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Perq Cervicothoracic Inj", "code_information": [ { "code": "22510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11978, "discounted_cash": 4601,"minimum": 1287,"maximum": 11379.1,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5848.86, "standard_charge_percentage": 48.8300, "estimated_amount": 5848, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 10480.8, "standard_charge_percentage": 87.5000, "estimated_amount": 10480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 11379.1, "standard_charge_percentage": 95.0000, "estimated_amount": 11379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 3296.94, "estimated_amount": 3296, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 10181.3, "standard_charge_percentage": 85.0000, "estimated_amount": 10181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3146.82, "estimated_amount": 3146, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4540.39, "estimated_amount": 4540, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3593.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2515.38, "standard_charge_percentage": 21.0000, "estimated_amount": 2515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3610.52, "estimated_amount": 3610, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2439.92, "standard_charge_percentage": 21.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4955.62, "estimated_amount": 4955, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3773.35, "estimated_amount": 3773, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2439.92, "standard_charge_percentage": 21.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2439.92, "standard_charge_percentage": 21.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2515.38, "standard_charge_percentage": 21.0000, "estimated_amount": 2515, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2490.23, "standard_charge_percentage": 21.0000, "estimated_amount": 2490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2389.61, "standard_charge_percentage": 21.0000, "estimated_amount": 2389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 8983.5, "standard_charge_percentage": 75.0000, "estimated_amount": 8983, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1287, "estimated_amount": 1287, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3610.52, "estimated_amount": 3610, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5989, "standard_charge_percentage": 50.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 4252.19, "standard_charge_percentage": 35.5000, "estimated_amount": 4252, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5854, "estimated_amount": 5854, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3716.72, "estimated_amount": 3716, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2389.61, "standard_charge_percentage": 21.0000, "estimated_amount": 2389, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2439.92, "standard_charge_percentage": 21.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2695.59, "estimated_amount": 2695, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 3296.94, "estimated_amount": 3296, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7186.8, "standard_charge_percentage": 60.0000, "estimated_amount": 7186, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 5989, "standard_charge_percentage": 50.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Perq Lumbosacral Inj", "code_information": [ { "code": "22511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11978, "discounted_cash": 4601,"minimum": 1287,"maximum": 11379.1,"payers_information":[{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2515.38, "standard_charge_percentage": 21.0000, "estimated_amount": 2515, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 10480.8, "standard_charge_percentage": 87.5000, "estimated_amount": 10480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2389.61, "standard_charge_percentage": 21.0000, "estimated_amount": 2389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5854, "estimated_amount": 5854, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7186.8, "standard_charge_percentage": 60.0000, "estimated_amount": 7186, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2389.61, "standard_charge_percentage": 21.0000, "estimated_amount": 2389, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 11379.1, "standard_charge_percentage": 95.0000, "estimated_amount": 11379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3716.72, "estimated_amount": 3716, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5848.86, "standard_charge_percentage": 48.8300, "estimated_amount": 5848, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3610.52, "estimated_amount": 3610, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2490.23, "standard_charge_percentage": 21.0000, "estimated_amount": 2490, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3146.82, "estimated_amount": 3146, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5989, "standard_charge_percentage": 50.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 10181.3, "standard_charge_percentage": 85.0000, "estimated_amount": 10181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3593.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4955.62, "estimated_amount": 4955, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 4252.19, "standard_charge_percentage": 35.5000, "estimated_amount": 4252, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3773.35, "estimated_amount": 3773, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1287, "estimated_amount": 1287, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 5989, "standard_charge_percentage": 50.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3610.52, "estimated_amount": 3610, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2439.92, "standard_charge_percentage": 21.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 3296.94, "estimated_amount": 3296, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2439.92, "standard_charge_percentage": 21.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 3296.94, "estimated_amount": 3296, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 8983.5, "standard_charge_percentage": 75.0000, "estimated_amount": 8983, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2439.92, "standard_charge_percentage": 21.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4540.39, "estimated_amount": 4540, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2439.92, "standard_charge_percentage": 21.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2515.38, "standard_charge_percentage": 21.0000, "estimated_amount": 2515, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2695.59, "estimated_amount": 2695, "methodology": "case rate" }]}]} , { "description": "Hc Perq Vertebroplasty Addl Inj", "code_information": [ { "code": "22512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3950.19,"minimum": 282,"maximum": 3774,"payers_information":[{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 829.54, "standard_charge_percentage": 21.0000, "estimated_amount": 829, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3160.15, "standard_charge_percentage": 80.0000, "estimated_amount": 3160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2765.13, "standard_charge_percentage": 70.0000, "estimated_amount": 2765, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3160.15, "standard_charge_percentage": 80.0000, "estimated_amount": 3160, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2765.13, "standard_charge_percentage": 70.0000, "estimated_amount": 2765, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 3357.66, "standard_charge_percentage": 85.0000, "estimated_amount": 3357, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1975.1, "standard_charge_percentage": 50.0000, "estimated_amount": 1975, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 804.65, "standard_charge_percentage": 21.0000, "estimated_amount": 804, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3160.15, "standard_charge_percentage": 80.0000, "estimated_amount": 3160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2370.11, "standard_charge_percentage": 60.0000, "estimated_amount": 2370, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 804.65, "standard_charge_percentage": 21.0000, "estimated_amount": 804, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2962.64, "standard_charge_percentage": 75.0000, "estimated_amount": 2962, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3160.15, "standard_charge_percentage": 80.0000, "estimated_amount": 3160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 788.06, "standard_charge_percentage": 21.0000, "estimated_amount": 788, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3160.15, "standard_charge_percentage": 80.0000, "estimated_amount": 3160, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3160.15, "standard_charge_percentage": 80.0000, "estimated_amount": 3160, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 3555.17, "standard_charge_percentage": 90.0000, "estimated_amount": 3555, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 804.65, "standard_charge_percentage": 21.0000, "estimated_amount": 804, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3160.15, "standard_charge_percentage": 80.0000, "estimated_amount": 3160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2765.13, "standard_charge_percentage": 70.0000, "estimated_amount": 2765, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 3456.42, "standard_charge_percentage": 87.5000, "estimated_amount": 3456, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 3555.17, "standard_charge_percentage": 90.0000, "estimated_amount": 3555, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1975.1, "standard_charge_percentage": 50.0000, "estimated_amount": 1975, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 3555.17, "standard_charge_percentage": 90.0000, "estimated_amount": 3555, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3752.68, "standard_charge_percentage": 95.0000, "estimated_amount": 3752, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 829.54, "standard_charge_percentage": 21.0000, "estimated_amount": 829, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3160.15, "standard_charge_percentage": 80.0000, "estimated_amount": 3160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1402.32, "standard_charge_percentage": 35.5000, "estimated_amount": 1402, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 788.06, "standard_charge_percentage": 21.0000, "estimated_amount": 788, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1185.06, "standard_charge_percentage": 30.0000, "estimated_amount": 1185, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3160.15, "standard_charge_percentage": 80.0000, "estimated_amount": 3160, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 804.65, "standard_charge_percentage": 21.0000, "estimated_amount": 804, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3160.15, "standard_charge_percentage": 80.0000, "estimated_amount": 3160, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 821.24, "standard_charge_percentage": 21.0000, "estimated_amount": 821, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Perq Vertebral Augmentation, Thoracic", "code_information": [ { "code": "22513", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28032.1, "discounted_cash": 10131,"minimum": 1383,"maximum": 26630.5,"payers_information":[{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 5886.74, "standard_charge_percentage": 21.0000, "estimated_amount": 5886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 13688.1, "standard_charge_percentage": 48.8300, "estimated_amount": 13688, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1383, "estimated_amount": 1383, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 25228.9, "standard_charge_percentage": 90.0000, "estimated_amount": 25228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 21024.1, "standard_charge_percentage": 75.0000, "estimated_amount": 21024, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 9951.4, "standard_charge_percentage": 35.5000, "estimated_amount": 9951, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 14016, "standard_charge_percentage": 50.0000, "estimated_amount": 14016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 8307.89, "estimated_amount": 8307, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 5710.14, "standard_charge_percentage": 21.0000, "estimated_amount": 5710, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 5710.14, "standard_charge_percentage": 21.0000, "estimated_amount": 5710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 14016, "standard_charge_percentage": 50.0000, "estimated_amount": 14016, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 5710.14, "standard_charge_percentage": 21.0000, "estimated_amount": 5710, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 26630.5, "standard_charge_percentage": 95.0000, "estimated_amount": 26630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 8011.04, "estimated_amount": 8011, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8409.63, "standard_charge_percentage": 30.0000, "estimated_amount": 8409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 5827.87, "standard_charge_percentage": 21.0000, "estimated_amount": 5827, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 5886.74, "standard_charge_percentage": 21.0000, "estimated_amount": 5886, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 23827.3, "standard_charge_percentage": 85.0000, "estimated_amount": 23827, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 13388.6, "estimated_amount": 13388, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 19622.5, "standard_charge_percentage": 70.0000, "estimated_amount": 19622, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 19622.5, "standard_charge_percentage": 70.0000, "estimated_amount": 19622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 25228.9, "standard_charge_percentage": 90.0000, "estimated_amount": 25228, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 25228.9, "standard_charge_percentage": 90.0000, "estimated_amount": 25228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 5592.4, "standard_charge_percentage": 21.0000, "estimated_amount": 5592, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 16819.3, "standard_charge_percentage": 60.0000, "estimated_amount": 16819, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 8183.2, "estimated_amount": 8183, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 8011.04, "estimated_amount": 8011, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 5592.4, "standard_charge_percentage": 21.0000, "estimated_amount": 5592, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 5710.14, "standard_charge_percentage": 21.0000, "estimated_amount": 5710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 6928.44, "estimated_amount": 6928, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 19622.5, "standard_charge_percentage": 70.0000, "estimated_amount": 19622, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10910.9, "estimated_amount": 10910, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 18572.2, "estimated_amount": 18572, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 24528.1, "standard_charge_percentage": 87.5000, "estimated_amount": 24528, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 7948.7, "estimated_amount": 7948, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6315, "estimated_amount": 6315, "methodology": "case rate" }]}]} , { "description": "Hc Perq Vertebral Augmentation, Lumbar", "code_information": [ { "code": "22514", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28032.1, "discounted_cash": 10131,"minimum": 1383,"maximum": 26630.5,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 25228.9, "standard_charge_percentage": 90.0000, "estimated_amount": 25228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 19622.5, "standard_charge_percentage": 70.0000, "estimated_amount": 19622, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 25228.9, "standard_charge_percentage": 90.0000, "estimated_amount": 25228, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 5886.74, "standard_charge_percentage": 21.0000, "estimated_amount": 5886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 5592.4, "standard_charge_percentage": 21.0000, "estimated_amount": 5592, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 5827.87, "standard_charge_percentage": 21.0000, "estimated_amount": 5827, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 5710.14, "standard_charge_percentage": 21.0000, "estimated_amount": 5710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 19622.5, "standard_charge_percentage": 70.0000, "estimated_amount": 19622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 18572.2, "estimated_amount": 18572, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 25228.9, "standard_charge_percentage": 90.0000, "estimated_amount": 25228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 5886.74, "standard_charge_percentage": 21.0000, "estimated_amount": 5886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 13688.1, "standard_charge_percentage": 48.8300, "estimated_amount": 13688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 6928.44, "estimated_amount": 6928, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 9951.4, "standard_charge_percentage": 35.5000, "estimated_amount": 9951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 5592.4, "standard_charge_percentage": 21.0000, "estimated_amount": 5592, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 19622.5, "standard_charge_percentage": 70.0000, "estimated_amount": 19622, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 14016, "standard_charge_percentage": 50.0000, "estimated_amount": 14016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 21024.1, "standard_charge_percentage": 75.0000, "estimated_amount": 21024, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 26630.5, "standard_charge_percentage": 95.0000, "estimated_amount": 26630, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 23827.3, "standard_charge_percentage": 85.0000, "estimated_amount": 23827, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 8307.89, "estimated_amount": 8307, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10910.9, "estimated_amount": 10910, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 5710.14, "standard_charge_percentage": 21.0000, "estimated_amount": 5710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 16819.3, "standard_charge_percentage": 60.0000, "estimated_amount": 16819, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 8011.04, "estimated_amount": 8011, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1383, "estimated_amount": 1383, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 7948.7, "estimated_amount": 7948, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 8183.2, "estimated_amount": 8183, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 24528.1, "standard_charge_percentage": 87.5000, "estimated_amount": 24528, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 14016, "standard_charge_percentage": 50.0000, "estimated_amount": 14016, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 5710.14, "standard_charge_percentage": 21.0000, "estimated_amount": 5710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 8011.04, "estimated_amount": 8011, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6315, "estimated_amount": 6315, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 13388.6, "estimated_amount": 13388, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8409.63, "standard_charge_percentage": 30.0000, "estimated_amount": 8409, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 5710.14, "standard_charge_percentage": 21.0000, "estimated_amount": 5710, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Perq Vertebral Augmentation Add, Thora Or Lumb", "code_information": [ { "code": "22515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18736.7,"minimum": 282,"maximum": 17799.9,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3816.67, "standard_charge_percentage": 21.0000, "estimated_amount": 3816, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 16863, "standard_charge_percentage": 90.0000, "estimated_amount": 16863, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 14989.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14989, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3934.71, "standard_charge_percentage": 21.0000, "estimated_amount": 3934, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 16863, "standard_charge_percentage": 90.0000, "estimated_amount": 16863, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 13115.7, "standard_charge_percentage": 70.0000, "estimated_amount": 13115, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 9368.35, "standard_charge_percentage": 50.0000, "estimated_amount": 9368, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 14989.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14989.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14989, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 15926.2, "standard_charge_percentage": 85.0000, "estimated_amount": 15926, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3737.97, "standard_charge_percentage": 21.0000, "estimated_amount": 3737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 9368.35, "standard_charge_percentage": 50.0000, "estimated_amount": 9368, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 14989.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14989.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14989, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3895.36, "standard_charge_percentage": 21.0000, "estimated_amount": 3895, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 17799.9, "standard_charge_percentage": 95.0000, "estimated_amount": 17799, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 16863, "standard_charge_percentage": 90.0000, "estimated_amount": 16863, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3816.67, "standard_charge_percentage": 21.0000, "estimated_amount": 3816, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 13115.7, "standard_charge_percentage": 70.0000, "estimated_amount": 13115, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5621.01, "standard_charge_percentage": 30.0000, "estimated_amount": 5621, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 16394.6, "standard_charge_percentage": 87.5000, "estimated_amount": 16394, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 14989.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14989, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 14989.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14989, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 14989.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14989, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 14052.5, "standard_charge_percentage": 75.0000, "estimated_amount": 14052, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 13115.7, "standard_charge_percentage": 70.0000, "estimated_amount": 13115, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 14989.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 11242, "standard_charge_percentage": 60.0000, "estimated_amount": 11242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3737.97, "standard_charge_percentage": 21.0000, "estimated_amount": 3737, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3816.67, "standard_charge_percentage": 21.0000, "estimated_amount": 3816, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 6651.53, "standard_charge_percentage": 35.5000, "estimated_amount": 6651, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3934.71, "standard_charge_percentage": 21.0000, "estimated_amount": 3934, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3816.67, "standard_charge_percentage": 21.0000, "estimated_amount": 3816, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 14989.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14989, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3869.38, "discounted_cash": 26081,"minimum": 1160.81,"maximum": 3869.38,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1608.89, "standard_charge_percentage": 42.0000, "estimated_amount": 1608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1576.39, "standard_charge_percentage": 42.0000, "estimated_amount": 1576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2708.57, "standard_charge_percentage": 70.0000, "estimated_amount": 2708, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3675.91, "standard_charge_percentage": 95.0000, "estimated_amount": 3675, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1576.39, "standard_charge_percentage": 42.0000, "estimated_amount": 1576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2321.63, "standard_charge_percentage": 60.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 3288.97, "standard_charge_percentage": 85.0000, "estimated_amount": 3288, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1543.88, "standard_charge_percentage": 42.0000, "estimated_amount": 1543, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1934.69, "standard_charge_percentage": 50.0000, "estimated_amount": 1934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1625.14, "standard_charge_percentage": 42.0000, "estimated_amount": 1625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1160.81, "standard_charge_percentage": 30.0000, "estimated_amount": 1160, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2708.57, "standard_charge_percentage": 70.0000, "estimated_amount": 2708, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2902.03, "standard_charge_percentage": 75.0000, "estimated_amount": 2902, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1383, "estimated_amount": 1383, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1625.14, "standard_charge_percentage": 42.0000, "estimated_amount": 1625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2708.57, "standard_charge_percentage": 70.0000, "estimated_amount": 2708, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 3482.44, "standard_charge_percentage": 90.0000, "estimated_amount": 3482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1889.42, "standard_charge_percentage": 48.8300, "estimated_amount": 1889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1543.88, "standard_charge_percentage": 42.0000, "estimated_amount": 1543, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 3385.71, "standard_charge_percentage": 87.5000, "estimated_amount": 3385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1576.39, "standard_charge_percentage": 42.0000, "estimated_amount": 1576, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1576.39, "standard_charge_percentage": 42.0000, "estimated_amount": 1576, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 3482.44, "standard_charge_percentage": 90.0000, "estimated_amount": 3482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 2272.38, "estimated_amount": 2272, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 3482.44, "standard_charge_percentage": 90.0000, "estimated_amount": 3482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 3869.38, "estimated_amount": 3869, "methodology": "case rate" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2919.64, "discounted_cash": 26081,"minimum": 682.9,"maximum": 2919.64,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2627.68, "standard_charge_percentage": 90.0000, "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1213.99, "standard_charge_percentage": 42.0000, "estimated_amount": 1213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2043.75, "standard_charge_percentage": 70.0000, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1751.78, "standard_charge_percentage": 60.0000, "estimated_amount": 1751, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1610, "estimated_amount": 1610, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2189.73, "standard_charge_percentage": 75.0000, "estimated_amount": 2189, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1226.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 875.89, "standard_charge_percentage": 30.0000, "estimated_amount": 875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2043.75, "standard_charge_percentage": 70.0000, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1459.82, "standard_charge_percentage": 50.0000, "estimated_amount": 1459, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1459.82, "standard_charge_percentage": 50.0000, "estimated_amount": 1459, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2773.66, "standard_charge_percentage": 95.0000, "estimated_amount": 2773, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2481.69, "standard_charge_percentage": 85.0000, "estimated_amount": 2481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1189.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1425.66, "standard_charge_percentage": 48.8300, "estimated_amount": 1425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2043.75, "standard_charge_percentage": 70.0000, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1164.94, "standard_charge_percentage": 42.0000, "estimated_amount": 1164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2554.68, "standard_charge_percentage": 87.5000, "estimated_amount": 2554, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2627.68, "standard_charge_percentage": 90.0000, "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1189.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1189.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1226.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1226, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1164.94, "standard_charge_percentage": 42.0000, "estimated_amount": 1164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1189.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2627.68, "standard_charge_percentage": 90.0000, "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 682.9, "standard_charge_percentage": 23.3900, "estimated_amount": 682, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 738.08, "standard_charge_percentage": 25.2800, "estimated_amount": 738, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 1956.16, "standard_charge_percentage": 67.0000, "estimated_amount": 1956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2919.64,"minimum": 282,"maximum": 2919.64,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2043.75, "standard_charge_percentage": 70.0000, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1189.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2627.68, "standard_charge_percentage": 90.0000, "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1164.94, "standard_charge_percentage": 42.0000, "estimated_amount": 1164, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1459.82, "standard_charge_percentage": 50.0000, "estimated_amount": 1459, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2481.69, "standard_charge_percentage": 85.0000, "estimated_amount": 2481, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 682.9, "standard_charge_percentage": 23.3900, "estimated_amount": 682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 875.89, "standard_charge_percentage": 30.0000, "estimated_amount": 875, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2773.66, "standard_charge_percentage": 95.0000, "estimated_amount": 2773, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1189.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1226.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1226, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 738.08, "standard_charge_percentage": 25.2800, "estimated_amount": 738, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1189.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1189.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2554.68, "standard_charge_percentage": 87.5000, "estimated_amount": 2554, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1213.99, "standard_charge_percentage": 42.0000, "estimated_amount": 1213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2189.73, "standard_charge_percentage": 75.0000, "estimated_amount": 2189, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2627.68, "standard_charge_percentage": 90.0000, "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1751.78, "standard_charge_percentage": 60.0000, "estimated_amount": 1751, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1164.94, "standard_charge_percentage": 42.0000, "estimated_amount": 1164, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2627.68, "standard_charge_percentage": 90.0000, "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2043.75, "standard_charge_percentage": 70.0000, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1226.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1226, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2043.75, "standard_charge_percentage": 70.0000, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22842", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3869.38,"minimum": 282,"maximum": 3774,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1543.88, "standard_charge_percentage": 42.0000, "estimated_amount": 1543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 978.18, "standard_charge_percentage": 25.2800, "estimated_amount": 978, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 3482.44, "standard_charge_percentage": 90.0000, "estimated_amount": 3482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1625.14, "standard_charge_percentage": 42.0000, "estimated_amount": 1625, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1576.39, "standard_charge_percentage": 42.0000, "estimated_amount": 1576, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1576.39, "standard_charge_percentage": 42.0000, "estimated_amount": 1576, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2708.57, "standard_charge_percentage": 70.0000, "estimated_amount": 2708, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1576.39, "standard_charge_percentage": 42.0000, "estimated_amount": 1576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1160.81, "standard_charge_percentage": 30.0000, "estimated_amount": 1160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 3482.44, "standard_charge_percentage": 90.0000, "estimated_amount": 3482, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1934.69, "standard_charge_percentage": 50.0000, "estimated_amount": 1934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2902.03, "standard_charge_percentage": 75.0000, "estimated_amount": 2902, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1625.14, "standard_charge_percentage": 42.0000, "estimated_amount": 1625, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 3288.97, "standard_charge_percentage": 85.0000, "estimated_amount": 3288, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 3482.44, "standard_charge_percentage": 90.0000, "estimated_amount": 3482, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2708.57, "standard_charge_percentage": 70.0000, "estimated_amount": 2708, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1543.88, "standard_charge_percentage": 42.0000, "estimated_amount": 1543, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 905.05, "standard_charge_percentage": 23.3900, "estimated_amount": 905, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 3385.71, "standard_charge_percentage": 87.5000, "estimated_amount": 3385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 3675.91, "standard_charge_percentage": 95.0000, "estimated_amount": 3675, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2321.63, "standard_charge_percentage": 60.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1608.89, "standard_charge_percentage": 42.0000, "estimated_amount": 1608, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1576.39, "standard_charge_percentage": 42.0000, "estimated_amount": 1576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2708.57, "standard_charge_percentage": 70.0000, "estimated_amount": 2708, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3095.5, "standard_charge_percentage": 80.0000, "estimated_amount": 3095, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2919.64,"minimum": 282,"maximum": 2919.64,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1189.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 2043.75, "standard_charge_percentage": 70.0000, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2627.68, "standard_charge_percentage": 90.0000, "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1226.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1459.82, "standard_charge_percentage": 50.0000, "estimated_amount": 1459, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2554.68, "standard_charge_percentage": 87.5000, "estimated_amount": 2554, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2481.69, "standard_charge_percentage": 85.0000, "estimated_amount": 2481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1459.82, "standard_charge_percentage": 50.0000, "estimated_amount": 1459, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1189.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1164.94, "standard_charge_percentage": 42.0000, "estimated_amount": 1164, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2773.66, "standard_charge_percentage": 95.0000, "estimated_amount": 2773, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1226.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1226, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1189.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 875.89, "standard_charge_percentage": 30.0000, "estimated_amount": 875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1213.99, "standard_charge_percentage": 42.0000, "estimated_amount": 1213, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2627.68, "standard_charge_percentage": 90.0000, "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1751.78, "standard_charge_percentage": 60.0000, "estimated_amount": 1751, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 2189.73, "standard_charge_percentage": 75.0000, "estimated_amount": 2189, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2627.68, "standard_charge_percentage": 90.0000, "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 2043.75, "standard_charge_percentage": 70.0000, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1164.94, "standard_charge_percentage": 42.0000, "estimated_amount": 1164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 2043.75, "standard_charge_percentage": 70.0000, "estimated_amount": 2043, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1189.46, "standard_charge_percentage": 42.0000, "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2919.64, "estimated_amount": 2919, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 2335.71, "standard_charge_percentage": 80.0000, "estimated_amount": 2335, "methodology": "percent of total billed charges" }]}]} , { "description": "EXC ABDL TUM DEEP < 5 CM", "code_information": [ { "code": "22900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7687.5, "discounted_cash": 4059,"minimum": 1216,"maximum": 7303.13,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3228.75, "standard_charge_percentage": 42.0000, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6726.56, "standard_charge_percentage": 87.5000, "estimated_amount": 6726, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6918.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2306.25, "standard_charge_percentage": 30.0000, "estimated_amount": 2306, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3843.75, "standard_charge_percentage": 50.0000, "estimated_amount": 3843, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5381.25, "standard_charge_percentage": 70.0000, "estimated_amount": 5381, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3131.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7303.13, "standard_charge_percentage": 95.0000, "estimated_amount": 7303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3196.46, "standard_charge_percentage": 42.0000, "estimated_amount": 3196, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3131.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3067.31, "standard_charge_percentage": 42.0000, "estimated_amount": 3067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3228.75, "standard_charge_percentage": 42.0000, "estimated_amount": 3228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5381.25, "standard_charge_percentage": 70.0000, "estimated_amount": 5381, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5765.63, "standard_charge_percentage": 75.0000, "estimated_amount": 5765, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3131.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3131, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6918.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6918.75, "standard_charge_percentage": 90.0000, "estimated_amount": 6918, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6534.38, "standard_charge_percentage": 85.0000, "estimated_amount": 6534, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3131.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3131, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3067.31, "standard_charge_percentage": 42.0000, "estimated_amount": 3067, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5381.25, "standard_charge_percentage": 70.0000, "estimated_amount": 5381, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4612.5, "standard_charge_percentage": 60.0000, "estimated_amount": 4612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3753.81, "standard_charge_percentage": 48.8300, "estimated_amount": 3753, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6150, "standard_charge_percentage": 80.0000, "estimated_amount": 6150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" }]}]} , { "description": "Exc abdl tum deep 5 cm/>", "code_information": [ { "code": "22901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9873.57, "discounted_cash": 4059,"minimum": 1216,"maximum": 9379.89,"payers_information":[{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 8392.53, "standard_charge_percentage": 85.0000, "estimated_amount": 8392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3939.55, "standard_charge_percentage": 42.0000, "estimated_amount": 3939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4936.78, "standard_charge_percentage": 50.0000, "estimated_amount": 4936, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6911.5, "standard_charge_percentage": 70.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6911.5, "standard_charge_percentage": 70.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 8886.21, "standard_charge_percentage": 90.0000, "estimated_amount": 8886, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4022.49, "standard_charge_percentage": 42.0000, "estimated_amount": 4022, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4146.9, "standard_charge_percentage": 42.0000, "estimated_amount": 4146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4105.43, "standard_charge_percentage": 42.0000, "estimated_amount": 4105, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 8639.37, "standard_charge_percentage": 87.5000, "estimated_amount": 8639, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4146.9, "standard_charge_percentage": 42.0000, "estimated_amount": 4146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 7405.18, "standard_charge_percentage": 75.0000, "estimated_amount": 7405, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6911.5, "standard_charge_percentage": 70.0000, "estimated_amount": 6911, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 8886.21, "standard_charge_percentage": 90.0000, "estimated_amount": 8886, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 9379.89, "standard_charge_percentage": 95.0000, "estimated_amount": 9379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 8886.21, "standard_charge_percentage": 90.0000, "estimated_amount": 8886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 7898.86, "standard_charge_percentage": 80.0000, "estimated_amount": 7898, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2962.07, "standard_charge_percentage": 30.0000, "estimated_amount": 2962, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5924.14, "standard_charge_percentage": 60.0000, "estimated_amount": 5924, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4022.49, "standard_charge_percentage": 42.0000, "estimated_amount": 4022, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4022.49, "standard_charge_percentage": 42.0000, "estimated_amount": 4022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3939.55, "standard_charge_percentage": 42.0000, "estimated_amount": 3939, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4022.49, "standard_charge_percentage": 42.0000, "estimated_amount": 4022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 4821.26, "standard_charge_percentage": 48.8300, "estimated_amount": 4821, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "22902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1028.99, "discounted_cash": 2297,"minimum": 308.7,"maximum": 1028.99,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 410.57, "standard_charge_percentage": 42.0000, "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 823.19, "standard_charge_percentage": 80.0000, "estimated_amount": 823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 823.19, "standard_charge_percentage": 80.0000, "estimated_amount": 823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 823.19, "standard_charge_percentage": 80.0000, "estimated_amount": 823, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 900.37, "standard_charge_percentage": 87.5000, "estimated_amount": 900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 502.46, "standard_charge_percentage": 48.8300, "estimated_amount": 502, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 926.09, "standard_charge_percentage": 90.0000, "estimated_amount": 926, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 419.21, "standard_charge_percentage": 42.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 771.74, "standard_charge_percentage": 75.0000, "estimated_amount": 771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 823.19, "standard_charge_percentage": 80.0000, "estimated_amount": 823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 926.09, "standard_charge_percentage": 90.0000, "estimated_amount": 926, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 419.21, "standard_charge_percentage": 42.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 617.39, "standard_charge_percentage": 60.0000, "estimated_amount": 617, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 874.64, "standard_charge_percentage": 85.0000, "estimated_amount": 874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 308.7, "standard_charge_percentage": 30.0000, "estimated_amount": 308, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 926.09, "standard_charge_percentage": 90.0000, "estimated_amount": 926, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 427.85, "standard_charge_percentage": 42.0000, "estimated_amount": 427, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 514.5, "standard_charge_percentage": 50.0000, "estimated_amount": 514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 823.19, "standard_charge_percentage": 80.0000, "estimated_amount": 823, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 823.19, "standard_charge_percentage": 80.0000, "estimated_amount": 823, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 432.18, "standard_charge_percentage": 42.0000, "estimated_amount": 432, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 823.19, "standard_charge_percentage": 80.0000, "estimated_amount": 823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 410.57, "standard_charge_percentage": 42.0000, "estimated_amount": 410, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 823.19, "standard_charge_percentage": 80.0000, "estimated_amount": 823, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 977.54, "standard_charge_percentage": 95.0000, "estimated_amount": 977, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 432.18, "standard_charge_percentage": 42.0000, "estimated_amount": 432, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 823.19, "standard_charge_percentage": 80.0000, "estimated_amount": 823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 419.21, "standard_charge_percentage": 42.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 720.29, "standard_charge_percentage": 70.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 419.21, "standard_charge_percentage": 42.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 823.19, "standard_charge_percentage": 80.0000, "estimated_amount": 823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 720.29, "standard_charge_percentage": 70.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 720.29, "standard_charge_percentage": 70.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1028.99, "estimated_amount": 1028, "methodology": "fee schedule" }]}]} , { "description": "Exc abd les sc 3 cm/>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7681.43, "discounted_cash": 4059,"minimum": 1216,"maximum": 7297.36,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3750.84, "standard_charge_percentage": 48.8300, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3064.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3064, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3193.94, "standard_charge_percentage": 42.0000, "estimated_amount": 3193, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3129.41, "standard_charge_percentage": 42.0000, "estimated_amount": 3129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5377, "standard_charge_percentage": 70.0000, "estimated_amount": 5377, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6145.14, "standard_charge_percentage": 80.0000, "estimated_amount": 6145, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3129.41, "standard_charge_percentage": 42.0000, "estimated_amount": 3129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5377, "standard_charge_percentage": 70.0000, "estimated_amount": 5377, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6913.29, "standard_charge_percentage": 90.0000, "estimated_amount": 6913, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6721.25, "standard_charge_percentage": 87.5000, "estimated_amount": 6721, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2304.43, "standard_charge_percentage": 30.0000, "estimated_amount": 2304, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6145.14, "standard_charge_percentage": 80.0000, "estimated_amount": 6145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6145.14, "standard_charge_percentage": 80.0000, "estimated_amount": 6145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6145.14, "standard_charge_percentage": 80.0000, "estimated_amount": 6145, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6913.29, "standard_charge_percentage": 90.0000, "estimated_amount": 6913, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5377, "standard_charge_percentage": 70.0000, "estimated_amount": 5377, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6913.29, "standard_charge_percentage": 90.0000, "estimated_amount": 6913, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7297.36, "standard_charge_percentage": 95.0000, "estimated_amount": 7297, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6145.14, "standard_charge_percentage": 80.0000, "estimated_amount": 6145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3226.2, "standard_charge_percentage": 42.0000, "estimated_amount": 3226, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6145.14, "standard_charge_percentage": 80.0000, "estimated_amount": 6145, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6145.14, "standard_charge_percentage": 80.0000, "estimated_amount": 6145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6145.14, "standard_charge_percentage": 80.0000, "estimated_amount": 6145, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3226.2, "standard_charge_percentage": 42.0000, "estimated_amount": 3226, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3129.41, "standard_charge_percentage": 42.0000, "estimated_amount": 3129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6145.14, "standard_charge_percentage": 80.0000, "estimated_amount": 6145, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6529.22, "standard_charge_percentage": 85.0000, "estimated_amount": 6529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6145.14, "standard_charge_percentage": 80.0000, "estimated_amount": 6145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4608.86, "standard_charge_percentage": 60.0000, "estimated_amount": 4608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3064.89, "standard_charge_percentage": 42.0000, "estimated_amount": 3064, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3129.41, "standard_charge_percentage": 42.0000, "estimated_amount": 3129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5761.07, "standard_charge_percentage": 75.0000, "estimated_amount": 5761, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3840.72, "standard_charge_percentage": 50.0000, "estimated_amount": 3840, "methodology": "percent of total billed charges" }]}]} , { "description": "DRAIN SHOULDER LESION", "code_information": [ { "code": "23030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 4059,"minimum": 519.96,"maximum": 6717.83,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1821.98, "estimated_amount": 1821, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1821.98, "estimated_amount": 1821, "methodology": "case rate" }]}]} , { "description": "BIOPSY SHOULDER TISSUES", "code_information": [ { "code": "23065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 2297,"minimum": 519.96,"maximum": 6717.83,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Biopsy Soft Tissue Shoulder Deep", "code_information": [ { "code": "23066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" }]}]} , { "description": "Exc Shoulder Les Sc 3 Cm/>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2297,"minimum": 1216,"maximum": 6234.38,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" }]}]} , { "description": "EXC SHOULDER TUM DEEP 5 CM>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8834.54, "discounted_cash": 4059,"minimum": 1216,"maximum": 8392.81,"payers_information":[{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3710.51, "standard_charge_percentage": 42.0000, "estimated_amount": 3710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 7067.63, "standard_charge_percentage": 80.0000, "estimated_amount": 7067, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 3599.19, "standard_charge_percentage": 42.0000, "estimated_amount": 3599, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 3599.19, "standard_charge_percentage": 42.0000, "estimated_amount": 3599, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3673.4, "standard_charge_percentage": 42.0000, "estimated_amount": 3673, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 7067.63, "standard_charge_percentage": 80.0000, "estimated_amount": 7067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 3599.19, "standard_charge_percentage": 42.0000, "estimated_amount": 3599, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3710.51, "standard_charge_percentage": 42.0000, "estimated_amount": 3710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 3524.98, "standard_charge_percentage": 42.0000, "estimated_amount": 3524, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 7067.63, "standard_charge_percentage": 80.0000, "estimated_amount": 7067, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 7067.63, "standard_charge_percentage": 80.0000, "estimated_amount": 7067, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 6184.18, "standard_charge_percentage": 70.0000, "estimated_amount": 6184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 7730.22, "standard_charge_percentage": 87.5000, "estimated_amount": 7730, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 8392.81, "standard_charge_percentage": 95.0000, "estimated_amount": 8392, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 7067.63, "standard_charge_percentage": 80.0000, "estimated_amount": 7067, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 7067.63, "standard_charge_percentage": 80.0000, "estimated_amount": 7067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2650.36, "standard_charge_percentage": 30.0000, "estimated_amount": 2650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5300.72, "standard_charge_percentage": 60.0000, "estimated_amount": 5300, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 7951.09, "standard_charge_percentage": 90.0000, "estimated_amount": 7951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 7509.36, "standard_charge_percentage": 85.0000, "estimated_amount": 7509, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 6625.91, "standard_charge_percentage": 75.0000, "estimated_amount": 6625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7067.63, "standard_charge_percentage": 80.0000, "estimated_amount": 7067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 4313.91, "standard_charge_percentage": 48.8300, "estimated_amount": 4313, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 3599.19, "standard_charge_percentage": 42.0000, "estimated_amount": 3599, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 6184.18, "standard_charge_percentage": 70.0000, "estimated_amount": 6184, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 4417.27, "standard_charge_percentage": 50.0000, "estimated_amount": 4417, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 7951.09, "standard_charge_percentage": 90.0000, "estimated_amount": 7951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7067.63, "standard_charge_percentage": 80.0000, "estimated_amount": 7067, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 7067.63, "standard_charge_percentage": 80.0000, "estimated_amount": 7067, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 7067.63, "standard_charge_percentage": 80.0000, "estimated_amount": 7067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 3524.98, "standard_charge_percentage": 42.0000, "estimated_amount": 3524, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 6184.18, "standard_charge_percentage": 70.0000, "estimated_amount": 6184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 7951.09, "standard_charge_percentage": 90.0000, "estimated_amount": 7951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" }]}]} , { "description": "EXC SHOULDER LES SC < 3 CM", "code_information": [ { "code": "23075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6234.38,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" }]}]} , { "description": "EXC SHOULDER TUM DEEP < 5 CM", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6234.38,"payers_information":[{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Inj Proc Shoulder Arthrography/Ct/Mri", "code_information": [ { "code": "23350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1206.59,"minimum": 240.71,"maximum": 1206.59,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 965.27, "standard_charge_percentage": 80.0000, "estimated_amount": 965, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 723.95, "standard_charge_percentage": 60.0000, "estimated_amount": 723, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 965.27, "standard_charge_percentage": 80.0000, "estimated_amount": 965, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 361.98, "standard_charge_percentage": 30.0000, "estimated_amount": 361, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 965.27, "standard_charge_percentage": 80.0000, "estimated_amount": 965, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 245.78, "standard_charge_percentage": 21.0000, "estimated_amount": 245, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1085.93, "standard_charge_percentage": 90.0000, "estimated_amount": 1085, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 965.27, "standard_charge_percentage": 80.0000, "estimated_amount": 965, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 253.38, "standard_charge_percentage": 21.0000, "estimated_amount": 253, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 965.27, "standard_charge_percentage": 80.0000, "estimated_amount": 965, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 965.27, "standard_charge_percentage": 80.0000, "estimated_amount": 965, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 240.71, "standard_charge_percentage": 21.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1085.93, "standard_charge_percentage": 90.0000, "estimated_amount": 1085, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 245.78, "standard_charge_percentage": 21.0000, "estimated_amount": 245, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 965.27, "standard_charge_percentage": 80.0000, "estimated_amount": 965, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1206.59, "estimated_amount": 1206, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 603.29, "standard_charge_percentage": 50.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1055.77, "standard_charge_percentage": 87.5000, "estimated_amount": 1055, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 965.27, "standard_charge_percentage": 80.0000, "estimated_amount": 965, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 844.61, "standard_charge_percentage": 70.0000, "estimated_amount": 844, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 965.27, "standard_charge_percentage": 80.0000, "estimated_amount": 965, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1146.26, "standard_charge_percentage": 95.0000, "estimated_amount": 1146, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 245.78, "standard_charge_percentage": 21.0000, "estimated_amount": 245, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1206.59, "estimated_amount": 1206, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 240.71, "standard_charge_percentage": 21.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1025.6, "standard_charge_percentage": 85.0000, "estimated_amount": 1025, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 250.85, "standard_charge_percentage": 21.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 253.38, "standard_charge_percentage": 21.0000, "estimated_amount": 253, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 245.78, "standard_charge_percentage": 21.0000, "estimated_amount": 245, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1085.93, "standard_charge_percentage": 90.0000, "estimated_amount": 1085, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 904.94, "standard_charge_percentage": 75.0000, "estimated_amount": 904, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 844.61, "standard_charge_percentage": 70.0000, "estimated_amount": 844, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 844.61, "standard_charge_percentage": 70.0000, "estimated_amount": 844, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 965.27, "standard_charge_percentage": 80.0000, "estimated_amount": 965, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" }]}]} , { "description": "Hc Clsd Treat Clavicle Fx Wo Manip", "code_information": [ { "code": "23500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1047, "discounted_cash": 340,"minimum": 150.15,"maximum": 1047,"payers_information":[{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 314.1, "standard_charge_percentage": 30.0000, "estimated_amount": 314, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1047, "estimated_amount": 1047, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 511.25, "standard_charge_percentage": 48.8300, "estimated_amount": 511, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 889.95, "standard_charge_percentage": 85.0000, "estimated_amount": 889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 994.65, "standard_charge_percentage": 95.0000, "estimated_amount": 994, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 523.5, "standard_charge_percentage": 50.0000, "estimated_amount": 523, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 628.2, "standard_charge_percentage": 60.0000, "estimated_amount": 628, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 785.25, "standard_charge_percentage": 75.0000, "estimated_amount": 785, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 916.13, "standard_charge_percentage": 87.5000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 217.67, "standard_charge_percentage": 21.0000, "estimated_amount": 217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" }]}]} , { "description": "CLTX CLAVICULAR FX WMNPJ", "code_information": [ { "code": "23505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 519.96,"maximum": 5208.14,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1867.57, "estimated_amount": 1867, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1867.57, "estimated_amount": 1867, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Sterno-Clav Disloc Wo Manip", "code_information": [ { "code": "23520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 519.96,"maximum": 5482.25,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5482.25, "estimated_amount": 5482, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" }]}]} , { "description": "Hc Clsd Treat Stern-Clav Disloc W Manip", "code_information": [ { "code": "23525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 861.65, "discounted_cash": 340,"minimum": 171.9,"maximum": 861.65,"payers_information":[{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 430.82, "standard_charge_percentage": 50.0000, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 753.94, "standard_charge_percentage": 87.5000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 258.5, "standard_charge_percentage": 30.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 732.4, "standard_charge_percentage": 85.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 646.24, "standard_charge_percentage": 75.0000, "estimated_amount": 646, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 420.74, "standard_charge_percentage": 48.8300, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 516.99, "standard_charge_percentage": 60.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 818.57, "standard_charge_percentage": 95.0000, "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 179.14, "standard_charge_percentage": 21.0000, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat A-C Jt Disloc Wo Manip", "code_information": [ { "code": "23540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 653, "discounted_cash": 340,"minimum": 130.27,"maximum": 653,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 195.9, "standard_charge_percentage": 30.0000, "estimated_amount": 195, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 489.75, "standard_charge_percentage": 75.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 457.1, "standard_charge_percentage": 70.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 457.1, "standard_charge_percentage": 70.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 135.76, "standard_charge_percentage": 21.0000, "estimated_amount": 135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 457.1, "standard_charge_percentage": 70.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 653, "estimated_amount": 653, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 326.5, "standard_charge_percentage": 50.0000, "estimated_amount": 326, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 137.13, "standard_charge_percentage": 21.0000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 587.7, "standard_charge_percentage": 90.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 571.38, "standard_charge_percentage": 87.5000, "estimated_amount": 571, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 653, "estimated_amount": 653, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 587.7, "standard_charge_percentage": 90.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 555.05, "standard_charge_percentage": 85.0000, "estimated_amount": 555, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 318.86, "standard_charge_percentage": 48.8300, "estimated_amount": 318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 620.35, "standard_charge_percentage": 95.0000, "estimated_amount": 620, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 653, "estimated_amount": 653, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 130.27, "standard_charge_percentage": 21.0000, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 137.13, "standard_charge_percentage": 21.0000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 587.7, "standard_charge_percentage": 90.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 391.8, "standard_charge_percentage": 60.0000, "estimated_amount": 391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 130.27, "standard_charge_percentage": 21.0000, "estimated_amount": 130, "methodology": "percent of total billed charges" }]}]} , { "description": "CLTX ACROMCLAV DISLC WMNPJ", "code_information": [ { "code": "23545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 861.65, "discounted_cash": 340,"minimum": 171.9,"maximum": 861.65,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 646.24, "standard_charge_percentage": 75.0000, "estimated_amount": 646, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 430.82, "standard_charge_percentage": 50.0000, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 258.5, "standard_charge_percentage": 30.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 753.94, "standard_charge_percentage": 87.5000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 818.57, "standard_charge_percentage": 95.0000, "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 179.14, "standard_charge_percentage": 21.0000, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 732.4, "standard_charge_percentage": 85.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 516.99, "standard_charge_percentage": 60.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 420.74, "standard_charge_percentage": 48.8300, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" }]}]} , { "description": "CLTX SCAPULAR FX WO MNPJ", "code_information": [ { "code": "23570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 861.65, "discounted_cash": 340,"minimum": 150.15,"maximum": 861.65,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 179.14, "standard_charge_percentage": 21.0000, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 646.24, "standard_charge_percentage": 75.0000, "estimated_amount": 646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 420.74, "standard_charge_percentage": 48.8300, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 732.4, "standard_charge_percentage": 85.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 753.94, "standard_charge_percentage": 87.5000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 516.99, "standard_charge_percentage": 60.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 430.82, "standard_charge_percentage": 50.0000, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 818.57, "standard_charge_percentage": 95.0000, "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 258.5, "standard_charge_percentage": 30.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" }]}]} , { "description": "CLTX SCAP FX WMNPJ +-TRACTJ", "code_information": [ { "code": "23575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 282,"maximum": 5208.14,"payers_information":[{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Prox Humerus Fx Wo Manip", "code_information": [ { "code": "23600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1047, "discounted_cash": 340,"minimum": 150.15,"maximum": 1047,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1047, "estimated_amount": 1047, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 628.2, "standard_charge_percentage": 60.0000, "estimated_amount": 628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 314.1, "standard_charge_percentage": 30.0000, "estimated_amount": 314, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 994.65, "standard_charge_percentage": 95.0000, "estimated_amount": 994, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 511.25, "standard_charge_percentage": 48.8300, "estimated_amount": 511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1047, "estimated_amount": 1047, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 785.25, "standard_charge_percentage": 75.0000, "estimated_amount": 785, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 217.67, "standard_charge_percentage": 21.0000, "estimated_amount": 217, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 889.95, "standard_charge_percentage": 85.0000, "estimated_amount": 889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 523.5, "standard_charge_percentage": 50.0000, "estimated_amount": 523, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 916.13, "standard_charge_percentage": 87.5000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Prox Humerus Fx W Manip", "code_information": [ { "code": "23605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7552, "discounted_cash": 2269,"minimum": 1045.33,"maximum": 7174.4,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5664, "standard_charge_percentage": 75.0000, "estimated_amount": 5664, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5286.4, "standard_charge_percentage": 70.0000, "estimated_amount": 5286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5286.4, "standard_charge_percentage": 70.0000, "estimated_amount": 5286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6608, "standard_charge_percentage": 87.5000, "estimated_amount": 6608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3687.64, "standard_charge_percentage": 48.8300, "estimated_amount": 3687, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1538.34, "standard_charge_percentage": 21.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1506.62, "standard_charge_percentage": 21.0000, "estimated_amount": 1506, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6796.8, "standard_charge_percentage": 90.0000, "estimated_amount": 6796, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7174.4, "standard_charge_percentage": 95.0000, "estimated_amount": 7174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1570.06, "standard_charge_percentage": 21.0000, "estimated_amount": 1570, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6796.8, "standard_charge_percentage": 90.0000, "estimated_amount": 6796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4531.2, "standard_charge_percentage": 60.0000, "estimated_amount": 4531, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3776, "standard_charge_percentage": 50.0000, "estimated_amount": 3776, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2758.17, "estimated_amount": 2758, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1538.34, "standard_charge_percentage": 21.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6419.2, "standard_charge_percentage": 85.0000, "estimated_amount": 6419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1538.34, "standard_charge_percentage": 21.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1867.57, "estimated_amount": 1867, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1637.5, "estimated_amount": 1637, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6796.8, "standard_charge_percentage": 90.0000, "estimated_amount": 6796, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1585.92, "standard_charge_percentage": 21.0000, "estimated_amount": 1585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5286.4, "standard_charge_percentage": 70.0000, "estimated_amount": 5286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1867.57, "estimated_amount": 1867, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1538.34, "standard_charge_percentage": 21.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2265.6, "standard_charge_percentage": 30.0000, "estimated_amount": 2265, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1585.92, "standard_charge_percentage": 21.0000, "estimated_amount": 1585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1506.62, "standard_charge_percentage": 21.0000, "estimated_amount": 1506, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Gr Tuberosity Hum Fx Wo Manip", "code_information": [ { "code": "23620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1047, "discounted_cash": 340,"minimum": 150.15,"maximum": 1047,"payers_information":[{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 523.5, "standard_charge_percentage": 50.0000, "estimated_amount": 523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 889.95, "standard_charge_percentage": 85.0000, "estimated_amount": 889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 628.2, "standard_charge_percentage": 60.0000, "estimated_amount": 628, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1047, "estimated_amount": 1047, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 217.67, "standard_charge_percentage": 21.0000, "estimated_amount": 217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 267.24, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 511.25, "standard_charge_percentage": 48.8300, "estimated_amount": 511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 916.13, "standard_charge_percentage": 87.5000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 314.1, "standard_charge_percentage": 30.0000, "estimated_amount": 314, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 994.65, "standard_charge_percentage": 95.0000, "estimated_amount": 994, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 785.25, "standard_charge_percentage": 75.0000, "estimated_amount": 785, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1047, "estimated_amount": 1047, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 450.13, "estimated_amount": 450, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Gr Tuber Hum Fx W Manip", "code_information": [ { "code": "23625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7552, "discounted_cash": 2269,"minimum": 1045.33,"maximum": 7174.4,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 7174.4, "standard_charge_percentage": 95.0000, "estimated_amount": 7174, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1538.34, "standard_charge_percentage": 21.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6796.8, "standard_charge_percentage": 90.0000, "estimated_amount": 6796, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3776, "standard_charge_percentage": 50.0000, "estimated_amount": 3776, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5286.4, "standard_charge_percentage": 70.0000, "estimated_amount": 5286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3687.64, "standard_charge_percentage": 48.8300, "estimated_amount": 3687, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5664, "standard_charge_percentage": 75.0000, "estimated_amount": 5664, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1585.92, "standard_charge_percentage": 21.0000, "estimated_amount": 1585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1585.92, "standard_charge_percentage": 21.0000, "estimated_amount": 1585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5286.4, "standard_charge_percentage": 70.0000, "estimated_amount": 5286, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1538.34, "standard_charge_percentage": 21.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4531.2, "standard_charge_percentage": 60.0000, "estimated_amount": 4531, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1538.34, "standard_charge_percentage": 21.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1867.57, "estimated_amount": 1867, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1538.34, "standard_charge_percentage": 21.0000, "estimated_amount": 1538, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5286.4, "standard_charge_percentage": 70.0000, "estimated_amount": 5286, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1506.62, "standard_charge_percentage": 21.0000, "estimated_amount": 1506, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1506.62, "standard_charge_percentage": 21.0000, "estimated_amount": 1506, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1867.57, "estimated_amount": 1867, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2265.6, "standard_charge_percentage": 30.0000, "estimated_amount": 2265, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6608, "standard_charge_percentage": 87.5000, "estimated_amount": 6608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 6041.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1570.06, "standard_charge_percentage": 21.0000, "estimated_amount": 1570, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6796.8, "standard_charge_percentage": 90.0000, "estimated_amount": 6796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6796.8, "standard_charge_percentage": 90.0000, "estimated_amount": 6796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6419.2, "standard_charge_percentage": 85.0000, "estimated_amount": 6419, "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": 1047, "discounted_cash": 340,"minimum": 150.15,"maximum": 1047,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 785.25, "standard_charge_percentage": 75.0000, "estimated_amount": 785, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1047, "estimated_amount": 1047, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 994.65, "standard_charge_percentage": 95.0000, "estimated_amount": 994, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 916.13, "standard_charge_percentage": 87.5000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 314.1, "standard_charge_percentage": 30.0000, "estimated_amount": 314, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 628.2, "standard_charge_percentage": 60.0000, "estimated_amount": 628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 523.5, "standard_charge_percentage": 50.0000, "estimated_amount": 523, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 889.95, "standard_charge_percentage": 85.0000, "estimated_amount": 889, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 511.25, "standard_charge_percentage": 48.8300, "estimated_amount": 511, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 217.67, "standard_charge_percentage": 21.0000, "estimated_amount": 217, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Shldr Disloc W Manip W Anes", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6963, "discounted_cash": 2269,"minimum": 519.96,"maximum": 6614.85,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2088.9, "standard_charge_percentage": 30.0000, "estimated_amount": 2088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1462.98, "estimated_amount": 1462, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6614.85, "standard_charge_percentage": 95.0000, "estimated_amount": 6614, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1418.36, "standard_charge_percentage": 21.0000, "estimated_amount": 1418, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5570.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1447.61, "standard_charge_percentage": 21.0000, "estimated_amount": 1447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1389.12, "standard_charge_percentage": 21.0000, "estimated_amount": 1389, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5570.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5570, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5570.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5570.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5570.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4874.1, "standard_charge_percentage": 70.0000, "estimated_amount": 4874, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6266.7, "standard_charge_percentage": 90.0000, "estimated_amount": 6266, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1418.36, "standard_charge_percentage": 21.0000, "estimated_amount": 1418, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5570.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4177.8, "standard_charge_percentage": 60.0000, "estimated_amount": 4177, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4874.1, "standard_charge_percentage": 70.0000, "estimated_amount": 4874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1462.98, "estimated_amount": 1462, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6092.63, "standard_charge_percentage": 87.5000, "estimated_amount": 6092, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5570.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1389.12, "standard_charge_percentage": 21.0000, "estimated_amount": 1389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5570.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3400.03, "standard_charge_percentage": 48.8300, "estimated_amount": 3400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1418.36, "standard_charge_percentage": 21.0000, "estimated_amount": 1418, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5222.25, "standard_charge_percentage": 75.0000, "estimated_amount": 5222, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1418.36, "standard_charge_percentage": 21.0000, "estimated_amount": 1418, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3481.5, "standard_charge_percentage": 50.0000, "estimated_amount": 3481, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6266.7, "standard_charge_percentage": 90.0000, "estimated_amount": 6266, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6266.7, "standard_charge_percentage": 90.0000, "estimated_amount": 6266, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1462.23, "standard_charge_percentage": 21.0000, "estimated_amount": 1462, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5918.55, "standard_charge_percentage": 85.0000, "estimated_amount": 5918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5570.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4874.1, "standard_charge_percentage": 70.0000, "estimated_amount": 4874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1462.23, "standard_charge_percentage": 21.0000, "estimated_amount": 1462, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5570.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" }]}]} , { "description": "CLTX SHO DSLC FX GR HMRL TBR", "code_information": [ { "code": "23665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 577.77,"maximum": 5208.14,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Shldr Disloc,Prox Hum Fx W Manip", "code_information": [ { "code": "23675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 150.15,"maximum": 5208.14,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" }]}]} , { "description": "I&D UPR AE DP ABSCHMTMA", "code_information": [ { "code": "23930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 4059,"minimum": 519.96,"maximum": 6717.83,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1821.98, "estimated_amount": 1821, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1821.98, "estimated_amount": 1821, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc I&D Arm/Elbow Infect Bursa", "code_information": [ { "code": "23931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1821.98, "estimated_amount": 1821, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1821.98, "estimated_amount": 1821, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Bx Arm/Elbow Soft Tissue,Superficial", "code_information": [ { "code": "24065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 2297,"minimum": 519.96,"maximum": 6717.83,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" }]}]} , { "description": "BIOPSY ARMELBOW SOFT TISSUE", "code_information": [ { "code": "24066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" }]}]} , { "description": "Exc arm/elbow les sc 3 cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 4059,"minimum": 1216,"maximum": 6234.38,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" }]}]} , { "description": "Exc arm/elbow les sc < 3 cm", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6234.38,"payers_information":[{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" }]}]} , { "description": "RMVL FB UPPER ARMELBW SUBQ", "code_information": [ { "code": "24200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2403.2, "discounted_cash": 2297,"minimum": 420.66,"maximum": 2403.2,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 1802.4, "standard_charge_percentage": 75.0000, "estimated_amount": 1802, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 1173.48, "standard_charge_percentage": 48.8300, "estimated_amount": 1173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 999.25, "standard_charge_percentage": 42.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 2162.88, "standard_charge_percentage": 90.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 979.06, "standard_charge_percentage": 42.0000, "estimated_amount": 979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 420.66, "estimated_amount": 420, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 910.96, "estimated_amount": 910, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 2283.04, "standard_charge_percentage": 95.0000, "estimated_amount": 2283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 958.88, "standard_charge_percentage": 42.0000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 2042.72, "standard_charge_percentage": 85.0000, "estimated_amount": 2042, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1441.92, "standard_charge_percentage": 60.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 1201.6, "standard_charge_percentage": 50.0000, "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1009.34, "standard_charge_percentage": 42.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 540.82, "estimated_amount": 540, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 2102.8, "standard_charge_percentage": 87.5000, "estimated_amount": 2102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 1682.24, "standard_charge_percentage": 70.0000, "estimated_amount": 1682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1922.56, "standard_charge_percentage": 80.0000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2403.2, "estimated_amount": 2403, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 720.96, "standard_charge_percentage": 30.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 2403.2, "estimated_amount": 2403, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" }]}]} , { "description": "Hc Injection For Elbow Arthrogram", "code_information": [ { "code": "24220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4292.2,"minimum": 282,"maximum": 4077.59,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 874.32, "standard_charge_percentage": 21.0000, "estimated_amount": 874, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 874.32, "standard_charge_percentage": 21.0000, "estimated_amount": 874, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 874.32, "standard_charge_percentage": 21.0000, "estimated_amount": 874, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3004.54, "standard_charge_percentage": 70.0000, "estimated_amount": 3004, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3433.76, "standard_charge_percentage": 80.0000, "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 901.36, "standard_charge_percentage": 21.0000, "estimated_amount": 901, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2146.1, "standard_charge_percentage": 50.0000, "estimated_amount": 2146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3433.76, "standard_charge_percentage": 80.0000, "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3433.76, "standard_charge_percentage": 80.0000, "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3433.76, "standard_charge_percentage": 80.0000, "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 856.29, "standard_charge_percentage": 21.0000, "estimated_amount": 856, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 3755.68, "standard_charge_percentage": 87.5000, "estimated_amount": 3755, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4077.59, "standard_charge_percentage": 95.0000, "estimated_amount": 4077, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 856.29, "standard_charge_percentage": 21.0000, "estimated_amount": 856, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2575.32, "standard_charge_percentage": 60.0000, "estimated_amount": 2575, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 3862.98, "standard_charge_percentage": 90.0000, "estimated_amount": 3862, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3433.76, "standard_charge_percentage": 80.0000, "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3433.76, "standard_charge_percentage": 80.0000, "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3004.54, "standard_charge_percentage": 70.0000, "estimated_amount": 3004, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 892.35, "standard_charge_percentage": 21.0000, "estimated_amount": 892, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1287.66, "standard_charge_percentage": 30.0000, "estimated_amount": 1287, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3433.76, "standard_charge_percentage": 80.0000, "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 3862.98, "standard_charge_percentage": 90.0000, "estimated_amount": 3862, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 901.36, "standard_charge_percentage": 21.0000, "estimated_amount": 901, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3433.76, "standard_charge_percentage": 80.0000, "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3219.15, "standard_charge_percentage": 75.0000, "estimated_amount": 3219, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 874.32, "standard_charge_percentage": 21.0000, "estimated_amount": 874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3433.76, "standard_charge_percentage": 80.0000, "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3004.54, "standard_charge_percentage": 70.0000, "estimated_amount": 3004, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 3648.37, "standard_charge_percentage": 85.0000, "estimated_amount": 3648, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 3862.98, "standard_charge_percentage": 90.0000, "estimated_amount": 3862, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3433.76, "standard_charge_percentage": 80.0000, "estimated_amount": 3433, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Mid Humerus Xf Wo Manip", "code_information": [ { "code": "24500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1047, "discounted_cash": 340,"minimum": 150.15,"maximum": 1047,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 785.25, "standard_charge_percentage": 75.0000, "estimated_amount": 785, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 916.13, "standard_charge_percentage": 87.5000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 267.24, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 314.1, "standard_charge_percentage": 30.0000, "estimated_amount": 314, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1047, "estimated_amount": 1047, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 217.67, "standard_charge_percentage": 21.0000, "estimated_amount": 217, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 523.5, "standard_charge_percentage": 50.0000, "estimated_amount": 523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 511.25, "standard_charge_percentage": 48.8300, "estimated_amount": 511, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 628.2, "standard_charge_percentage": 60.0000, "estimated_amount": 628, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 889.95, "standard_charge_percentage": 85.0000, "estimated_amount": 889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 994.65, "standard_charge_percentage": 95.0000, "estimated_amount": 994, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 450.13, "estimated_amount": 450, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Mid Humerus Fx W Manip", "code_information": [ { "code": "24505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 150.15,"maximum": 5208.14,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "case rate" }]}]} , { "description": "Hc Clsd Treat Humeral Supracondylar Fx Wo Manip", "code_information": [ { "code": "24530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1187.5, "discounted_cash": 340,"minimum": 150.15,"maximum": 1187.5,"payers_information":[{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1128.13, "standard_charge_percentage": 95.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 593.75, "standard_charge_percentage": 50.0000, "estimated_amount": 593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 246.88, "standard_charge_percentage": 21.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 712.5, "standard_charge_percentage": 60.0000, "estimated_amount": 712, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 267.24, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 579.86, "standard_charge_percentage": 48.8300, "estimated_amount": 579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 450.13, "estimated_amount": 450, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1009.38, "standard_charge_percentage": 85.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 890.63, "standard_charge_percentage": 75.0000, "estimated_amount": 890, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1187.5, "estimated_amount": 1187, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1039.06, "standard_charge_percentage": 87.5000, "estimated_amount": 1039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 356.25, "standard_charge_percentage": 30.0000, "estimated_amount": 356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Hum Supracondylr Fx W Manip", "code_information": [ { "code": "24535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 282,"maximum": 5208.14,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Humer Epicondylr Fx Wo Manip", "code_information": [ { "code": "24560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 861.65, "discounted_cash": 340,"minimum": 150.15,"maximum": 861.65,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 753.94, "standard_charge_percentage": 87.5000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 179.14, "standard_charge_percentage": 21.0000, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 646.24, "standard_charge_percentage": 75.0000, "estimated_amount": 646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 818.57, "standard_charge_percentage": 95.0000, "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 420.74, "standard_charge_percentage": 48.8300, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 430.82, "standard_charge_percentage": 50.0000, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 732.4, "standard_charge_percentage": 85.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 516.99, "standard_charge_percentage": 60.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 258.5, "standard_charge_percentage": 30.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Humer Epicondylr Fx W Manip", "code_information": [ { "code": "24565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 150.15,"maximum": 5208.14,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT HUMERUS FRACTURE", "code_information": [ { "code": "24576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1187.5, "discounted_cash": 340,"minimum": 150.15,"maximum": 1187.5,"payers_information":[{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 712.5, "standard_charge_percentage": 60.0000, "estimated_amount": 712, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 246.88, "standard_charge_percentage": 21.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1187.5, "estimated_amount": 1187, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 593.75, "standard_charge_percentage": 50.0000, "estimated_amount": 593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 450.13, "estimated_amount": 450, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1128.13, "standard_charge_percentage": 95.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 890.63, "standard_charge_percentage": 75.0000, "estimated_amount": 890, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1009.38, "standard_charge_percentage": 85.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 267.24, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 356.25, "standard_charge_percentage": 30.0000, "estimated_amount": 356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1039.06, "standard_charge_percentage": 87.5000, "estimated_amount": 1039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 579.86, "standard_charge_percentage": 48.8300, "estimated_amount": 579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Humer Condylr Fx W Manip", "code_information": [ { "code": "24577", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 282,"maximum": 5208.14,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Elbow Disloc Wo Anes", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1047, "discounted_cash": 340,"minimum": 150.15,"maximum": 1047,"payers_information":[{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 314.1, "standard_charge_percentage": 30.0000, "estimated_amount": 314, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1047, "estimated_amount": 1047, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 785.25, "standard_charge_percentage": 75.0000, "estimated_amount": 785, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 916.13, "standard_charge_percentage": 87.5000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 994.65, "standard_charge_percentage": 95.0000, "estimated_amount": 994, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 628.2, "standard_charge_percentage": 60.0000, "estimated_amount": 628, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 889.95, "standard_charge_percentage": 85.0000, "estimated_amount": 889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 217.67, "standard_charge_percentage": 21.0000, "estimated_amount": 217, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 523.5, "standard_charge_percentage": 50.0000, "estimated_amount": 523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 511.25, "standard_charge_percentage": 48.8300, "estimated_amount": 511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" }]}]} , { "description": "TREAT ELBOW DISLOCATION", "code_information": [ { "code": "24605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5200, "discounted_cash": 2269,"minimum": 1045.33,"maximum": 5482.25,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4680, "standard_charge_percentage": 90.0000, "estimated_amount": 4680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5200, "estimated_amount": 5200, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2118.48, "standard_charge_percentage": 42.0000, "estimated_amount": 2118, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4160, "standard_charge_percentage": 80.0000, "estimated_amount": 4160, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3640, "standard_charge_percentage": 70.0000, "estimated_amount": 3640, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3120, "standard_charge_percentage": 60.0000, "estimated_amount": 3120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2074.8, "standard_charge_percentage": 42.0000, "estimated_amount": 2074, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4680, "standard_charge_percentage": 90.0000, "estimated_amount": 4680, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4160, "standard_charge_percentage": 80.0000, "estimated_amount": 4160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3640, "standard_charge_percentage": 70.0000, "estimated_amount": 3640, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4680, "standard_charge_percentage": 90.0000, "estimated_amount": 4680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1462.98, "estimated_amount": 1462, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2118.48, "standard_charge_percentage": 42.0000, "estimated_amount": 2118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2539.16, "standard_charge_percentage": 48.8300, "estimated_amount": 2539, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4160, "standard_charge_percentage": 80.0000, "estimated_amount": 4160, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2118.48, "standard_charge_percentage": 42.0000, "estimated_amount": 2118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2074.8, "standard_charge_percentage": 42.0000, "estimated_amount": 2074, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2184, "standard_charge_percentage": 42.0000, "estimated_amount": 2184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2162.16, "standard_charge_percentage": 42.0000, "estimated_amount": 2162, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1462.98, "estimated_amount": 1462, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4160, "standard_charge_percentage": 80.0000, "estimated_amount": 4160, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3640, "standard_charge_percentage": 70.0000, "estimated_amount": 3640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5482.25, "estimated_amount": 5482, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4940, "standard_charge_percentage": 95.0000, "estimated_amount": 4940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4160, "standard_charge_percentage": 80.0000, "estimated_amount": 4160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1462.98, "estimated_amount": 1462, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4160, "standard_charge_percentage": 80.0000, "estimated_amount": 4160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4160, "standard_charge_percentage": 80.0000, "estimated_amount": 4160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1560, "standard_charge_percentage": 30.0000, "estimated_amount": 1560, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2184, "standard_charge_percentage": 42.0000, "estimated_amount": 2184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4160, "standard_charge_percentage": 80.0000, "estimated_amount": 4160, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4550, "standard_charge_percentage": 87.5000, "estimated_amount": 4550, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2600, "standard_charge_percentage": 50.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3900, "standard_charge_percentage": 75.0000, "estimated_amount": 3900, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4420, "standard_charge_percentage": 85.0000, "estimated_amount": 4420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4160, "standard_charge_percentage": 80.0000, "estimated_amount": 4160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4160, "standard_charge_percentage": 80.0000, "estimated_amount": 4160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2118.48, "standard_charge_percentage": 42.0000, "estimated_amount": 2118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1462.98, "estimated_amount": 1462, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT ELBOW FRACTURE", "code_information": [ { "code": "24620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 1045.33,"maximum": 5482.25,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1867.57, "estimated_amount": 1867, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5482.25, "estimated_amount": 5482, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1867.57, "estimated_amount": 1867, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" }]}]} , { "description": "Hc Open Treat Elbow Xf", "code_information": [ { "code": "24635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28032.1, "discounted_cash": 10131,"minimum": 1383,"maximum": 26630.5,"payers_information":[{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 24528.1, "standard_charge_percentage": 87.5000, "estimated_amount": 24528, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 14016, "standard_charge_percentage": 50.0000, "estimated_amount": 14016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 21024.1, "standard_charge_percentage": 75.0000, "estimated_amount": 21024, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 5880.12, "estimated_amount": 5880, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 13688.1, "standard_charge_percentage": 48.8300, "estimated_amount": 13688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 8307.89, "estimated_amount": 8307, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8409.63, "standard_charge_percentage": 30.0000, "estimated_amount": 8409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 6928.44, "estimated_amount": 6928, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 5880.12, "estimated_amount": 5880, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 5886.74, "standard_charge_percentage": 21.0000, "estimated_amount": 5886, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 26630.5, "standard_charge_percentage": 95.0000, "estimated_amount": 26630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 25228.9, "standard_charge_percentage": 90.0000, "estimated_amount": 25228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 5592.4, "standard_charge_percentage": 21.0000, "estimated_amount": 5592, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 23827.3, "standard_charge_percentage": 85.0000, "estimated_amount": 23827, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 7948.7, "estimated_amount": 7948, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 25228.9, "standard_charge_percentage": 90.0000, "estimated_amount": 25228, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 5710.14, "standard_charge_percentage": 21.0000, "estimated_amount": 5710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10910.9, "estimated_amount": 10910, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 19622.5, "standard_charge_percentage": 70.0000, "estimated_amount": 19622, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 5592.4, "standard_charge_percentage": 21.0000, "estimated_amount": 5592, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 5827.87, "standard_charge_percentage": 21.0000, "estimated_amount": 5827, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 5710.14, "standard_charge_percentage": 21.0000, "estimated_amount": 5710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 13388.6, "estimated_amount": 13388, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 19622.5, "standard_charge_percentage": 70.0000, "estimated_amount": 19622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 16819.3, "standard_charge_percentage": 60.0000, "estimated_amount": 16819, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 8183.2, "estimated_amount": 8183, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 5886.74, "standard_charge_percentage": 21.0000, "estimated_amount": 5886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1383, "estimated_amount": 1383, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 5710.14, "standard_charge_percentage": 21.0000, "estimated_amount": 5710, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6315, "estimated_amount": 6315, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 25228.9, "standard_charge_percentage": 90.0000, "estimated_amount": 25228, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 22425.7, "standard_charge_percentage": 80.0000, "estimated_amount": 22425, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 5710.14, "standard_charge_percentage": 21.0000, "estimated_amount": 5710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 19622.5, "standard_charge_percentage": 70.0000, "estimated_amount": 19622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Radial Head Disloc Child W Amnip", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1047, "discounted_cash": 340,"minimum": 112.04,"maximum": 1047,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 217.67, "standard_charge_percentage": 21.0000, "estimated_amount": 217, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 916.13, "standard_charge_percentage": 87.5000, "estimated_amount": 916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 511.25, "standard_charge_percentage": 48.8300, "estimated_amount": 511, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 314.1, "standard_charge_percentage": 30.0000, "estimated_amount": 314, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 450.13, "estimated_amount": 450, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1047, "estimated_amount": 1047, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 994.65, "standard_charge_percentage": 95.0000, "estimated_amount": 994, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 628.2, "standard_charge_percentage": 60.0000, "estimated_amount": 628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 785.25, "standard_charge_percentage": 75.0000, "estimated_amount": 785, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1047, "estimated_amount": 1047, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 208.88, "standard_charge_percentage": 21.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 523.5, "standard_charge_percentage": 50.0000, "estimated_amount": 523, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 219.87, "standard_charge_percentage": 21.0000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 267.24, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 213.27, "standard_charge_percentage": 21.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 942.3, "standard_charge_percentage": 90.0000, "estimated_amount": 942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 732.9, "standard_charge_percentage": 70.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 889.95, "standard_charge_percentage": 85.0000, "estimated_amount": 889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 837.6, "standard_charge_percentage": 80.0000, "estimated_amount": 837, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT RADIUS FRACTURE", "code_information": [ { "code": "24650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 861.65, "discounted_cash": 340,"minimum": 112.04,"maximum": 861.65,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 258.5, "standard_charge_percentage": 30.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 732.4, "standard_charge_percentage": 85.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 753.94, "standard_charge_percentage": 87.5000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 818.57, "standard_charge_percentage": 95.0000, "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 430.82, "standard_charge_percentage": 50.0000, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 179.14, "standard_charge_percentage": 21.0000, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 646.24, "standard_charge_percentage": 75.0000, "estimated_amount": 646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 420.74, "standard_charge_percentage": 48.8300, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 516.99, "standard_charge_percentage": 60.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Radial Head/Neck Fx W Manip", "code_information": [ { "code": "24655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 282,"maximum": 5208.14,"payers_information":[{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Ulnar Xf Prox End Wo Manip", "code_information": [ { "code": "24670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 653, "discounted_cash": 340,"minimum": 130.27,"maximum": 653,"payers_information":[{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 555.05, "standard_charge_percentage": 85.0000, "estimated_amount": 555, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 137.13, "standard_charge_percentage": 21.0000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 653, "estimated_amount": 653, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 391.8, "standard_charge_percentage": 60.0000, "estimated_amount": 391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 135.76, "standard_charge_percentage": 21.0000, "estimated_amount": 135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 587.7, "standard_charge_percentage": 90.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 489.75, "standard_charge_percentage": 75.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 653, "estimated_amount": 653, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 318.86, "standard_charge_percentage": 48.8300, "estimated_amount": 318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 195.9, "standard_charge_percentage": 30.0000, "estimated_amount": 195, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 137.13, "standard_charge_percentage": 21.0000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 457.1, "standard_charge_percentage": 70.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 457.1, "standard_charge_percentage": 70.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 130.27, "standard_charge_percentage": 21.0000, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 587.7, "standard_charge_percentage": 90.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 130.27, "standard_charge_percentage": 21.0000, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 620.35, "standard_charge_percentage": 95.0000, "estimated_amount": 620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 326.5, "standard_charge_percentage": 50.0000, "estimated_amount": 326, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 457.1, "standard_charge_percentage": 70.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 653, "estimated_amount": 653, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 571.38, "standard_charge_percentage": 87.5000, "estimated_amount": 571, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 587.7, "standard_charge_percentage": 90.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Ulnar Fx Prox End W Manip", "code_information": [ { "code": "24675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 150.15,"maximum": 5208.14,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" }]}]} , { "description": "Hc Upper Arm/Elbow Surgery Unlisted", "code_information": [ { "code": "24999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1052.5, "discounted_cash": 340,"minimum": 112.04,"maximum": 1052.5,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 999.88, "standard_charge_percentage": 95.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 631.5, "standard_charge_percentage": 60.0000, "estimated_amount": 631, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1052.5, "estimated_amount": 1052, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 947.25, "standard_charge_percentage": 90.0000, "estimated_amount": 947, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 209.97, "standard_charge_percentage": 21.0000, "estimated_amount": 209, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 789.38, "standard_charge_percentage": 75.0000, "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 947.25, "standard_charge_percentage": 90.0000, "estimated_amount": 947, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 842, "standard_charge_percentage": 80.0000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 513.94, "standard_charge_percentage": 48.8300, "estimated_amount": 513, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 221.03, "standard_charge_percentage": 21.0000, "estimated_amount": 221, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 736.75, "standard_charge_percentage": 70.0000, "estimated_amount": 736, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 526.25, "standard_charge_percentage": 50.0000, "estimated_amount": 526, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 920.94, "standard_charge_percentage": 87.5000, "estimated_amount": 920, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 842, "standard_charge_percentage": 80.0000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 736.75, "standard_charge_percentage": 70.0000, "estimated_amount": 736, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 947.25, "standard_charge_percentage": 90.0000, "estimated_amount": 947, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 214.39, "standard_charge_percentage": 21.0000, "estimated_amount": 214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 307.93, "estimated_amount": 307, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 736.75, "standard_charge_percentage": 70.0000, "estimated_amount": 736, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 842, "standard_charge_percentage": 80.0000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 894.63, "standard_charge_percentage": 85.0000, "estimated_amount": 894, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 842, "standard_charge_percentage": 80.0000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 842, "standard_charge_percentage": 80.0000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 214.39, "standard_charge_percentage": 21.0000, "estimated_amount": 214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 209.97, "standard_charge_percentage": 21.0000, "estimated_amount": 209, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 842, "standard_charge_percentage": 80.0000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 842, "standard_charge_percentage": 80.0000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 842, "standard_charge_percentage": 80.0000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 842, "standard_charge_percentage": 80.0000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 218.81, "standard_charge_percentage": 21.0000, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1052.5, "estimated_amount": 1052, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 842, "standard_charge_percentage": 80.0000, "estimated_amount": 842, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 214.39, "standard_charge_percentage": 21.0000, "estimated_amount": 214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 214.39, "standard_charge_percentage": 21.0000, "estimated_amount": 214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 221.03, "standard_charge_percentage": 21.0000, "estimated_amount": 221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 315.75, "standard_charge_percentage": 30.0000, "estimated_amount": 315, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" }]}]} , { "description": "Hc I&D Forearm Deep Abscess", "code_information": [ { "code": "25028", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7276.3, "discounted_cash": 4601,"minimum": 519.96,"maximum": 6912.48,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6548.67, "standard_charge_percentage": 90.0000, "estimated_amount": 6548, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 3146.82, "estimated_amount": 3146, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5093.41, "standard_charge_percentage": 70.0000, "estimated_amount": 5093, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3638.15, "standard_charge_percentage": 50.0000, "estimated_amount": 3638, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3716.72, "estimated_amount": 3716, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3056.05, "standard_charge_percentage": 42.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6912.48, "standard_charge_percentage": 95.0000, "estimated_amount": 6912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2964.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2964, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6366.76, "standard_charge_percentage": 87.5000, "estimated_amount": 6366, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2758.17, "estimated_amount": 2758, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3610.52, "estimated_amount": 3610, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2964.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2964, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2964.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2964, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6548.67, "standard_charge_percentage": 90.0000, "estimated_amount": 6548, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2903.24, "standard_charge_percentage": 42.0000, "estimated_amount": 2903, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6548.67, "standard_charge_percentage": 90.0000, "estimated_amount": 6548, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4365.78, "standard_charge_percentage": 60.0000, "estimated_amount": 4365, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3553.02, "standard_charge_percentage": 48.8300, "estimated_amount": 3553, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2903.24, "standard_charge_percentage": 42.0000, "estimated_amount": 2903, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2964.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2964, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5093.41, "standard_charge_percentage": 70.0000, "estimated_amount": 5093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5093.41, "standard_charge_percentage": 70.0000, "estimated_amount": 5093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3056.05, "standard_charge_percentage": 42.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4955.62, "estimated_amount": 4955, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5457.23, "standard_charge_percentage": 75.0000, "estimated_amount": 5457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2182.89, "standard_charge_percentage": 30.0000, "estimated_amount": 2182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6184.85, "standard_charge_percentage": 85.0000, "estimated_amount": 6184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3610.52, "estimated_amount": 3610, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3773.35, "estimated_amount": 3773, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3539.73, "estimated_amount": 3539, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3025.49, "standard_charge_percentage": 42.0000, "estimated_amount": 3025, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1637.5, "estimated_amount": 1637, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2046.94, "estimated_amount": 2046, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2046.94, "estimated_amount": 2046, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc I&D Forearm Infected Bursa", "code_information": [ { "code": "25031", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7276.3, "discounted_cash": 2269,"minimum": 1045.33,"maximum": 6912.48,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1637.5, "estimated_amount": 1637, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6548.67, "standard_charge_percentage": 90.0000, "estimated_amount": 6548, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6366.76, "standard_charge_percentage": 87.5000, "estimated_amount": 6366, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3638.15, "standard_charge_percentage": 50.0000, "estimated_amount": 3638, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6548.67, "standard_charge_percentage": 90.0000, "estimated_amount": 6548, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5093.41, "standard_charge_percentage": 70.0000, "estimated_amount": 5093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2046.94, "estimated_amount": 2046, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2758.17, "estimated_amount": 2758, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3025.49, "standard_charge_percentage": 42.0000, "estimated_amount": 3025, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6912.48, "standard_charge_percentage": 95.0000, "estimated_amount": 6912, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2964.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2964, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4365.78, "standard_charge_percentage": 60.0000, "estimated_amount": 4365, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3553.02, "standard_charge_percentage": 48.8300, "estimated_amount": 3553, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3056.05, "standard_charge_percentage": 42.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6184.85, "standard_charge_percentage": 85.0000, "estimated_amount": 6184, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2964.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2964, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2964.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2964, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6548.67, "standard_charge_percentage": 90.0000, "estimated_amount": 6548, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2046.94, "estimated_amount": 2046, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2964.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2964, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5093.41, "standard_charge_percentage": 70.0000, "estimated_amount": 5093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2903.24, "standard_charge_percentage": 42.0000, "estimated_amount": 2903, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5093.41, "standard_charge_percentage": 70.0000, "estimated_amount": 5093, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3056.05, "standard_charge_percentage": 42.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5457.23, "standard_charge_percentage": 75.0000, "estimated_amount": 5457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2182.89, "standard_charge_percentage": 30.0000, "estimated_amount": 2182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2903.24, "standard_charge_percentage": 42.0000, "estimated_amount": 2903, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" }]}]} , { "description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [ { "code": "25065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4709.9, "discounted_cash": 2297,"minimum": 519.96,"maximum": 4474.4,"payers_information":[{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2825.94, "standard_charge_percentage": 60.0000, "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4003.41, "standard_charge_percentage": 85.0000, "estimated_amount": 4003, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3296.93, "standard_charge_percentage": 70.0000, "estimated_amount": 3296, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1059.94, "estimated_amount": 1059, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1785.34, "estimated_amount": 1785, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 775.94, "estimated_amount": 775, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4121.16, "standard_charge_percentage": 87.5000, "estimated_amount": 4121, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 4474.4, "standard_charge_percentage": 95.0000, "estimated_amount": 4474, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1412.97, "standard_charge_percentage": 30.0000, "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 3532.43, "standard_charge_percentage": 75.0000, "estimated_amount": 3532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4238.91, "standard_charge_percentage": 90.0000, "estimated_amount": 4238, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1958.38, "standard_charge_percentage": 42.0000, "estimated_amount": 1958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1879.25, "standard_charge_percentage": 42.0000, "estimated_amount": 1879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2299.84, "standard_charge_percentage": 48.8300, "estimated_amount": 2299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1978.16, "standard_charge_percentage": 42.0000, "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 3767.92, "standard_charge_percentage": 80.0000, "estimated_amount": 3767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1918.81, "standard_charge_percentage": 42.0000, "estimated_amount": 1918, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2354.95, "standard_charge_percentage": 50.0000, "estimated_amount": 2354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" }]}]} , { "description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [ { "code": "25066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 4059,"minimum": 1045.33,"maximum": 6717.83,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2940.29, "standard_charge_percentage": 42.0000, "estimated_amount": 2940, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6187.48, "standard_charge_percentage": 87.5000, "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 2775.8, "estimated_amount": 2775, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2821.49, "standard_charge_percentage": 42.0000, "estimated_amount": 2821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5303.55, "standard_charge_percentage": 75.0000, "estimated_amount": 5303, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2969.99, "standard_charge_percentage": 42.0000, "estimated_amount": 2969, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3535.7, "standard_charge_percentage": 50.0000, "estimated_amount": 3535, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2880.89, "standard_charge_percentage": 42.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4242.84, "standard_charge_percentage": 60.0000, "estimated_amount": 4242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 4371.33, "estimated_amount": 4371, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 3278.5, "estimated_amount": 3278, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 3184.83, "estimated_amount": 3184, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2121.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6010.69, "standard_charge_percentage": 85.0000, "estimated_amount": 6010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4949.98, "standard_charge_percentage": 70.0000, "estimated_amount": 4949, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6717.83, "standard_charge_percentage": 95.0000, "estimated_amount": 6717, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 3328.46, "estimated_amount": 3328, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6364.26, "standard_charge_percentage": 90.0000, "estimated_amount": 6364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3452.96, "standard_charge_percentage": 48.8300, "estimated_amount": 3452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3122.38, "estimated_amount": 3122, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5657.12, "standard_charge_percentage": 80.0000, "estimated_amount": 5657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2052.75, "estimated_amount": 2052, "methodology": "case rate" }]}]} , { "description": "Exc Forearm Les Sc 3 Cm/>", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6879.17, "discounted_cash": 2297,"minimum": 1216,"maximum": 6535.21,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6191.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3359.1, "standard_charge_percentage": 48.8300, "estimated_amount": 3359, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2744.79, "standard_charge_percentage": 42.0000, "estimated_amount": 2744, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2063.75, "standard_charge_percentage": 30.0000, "estimated_amount": 2063, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6535.21, "standard_charge_percentage": 95.0000, "estimated_amount": 6535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5847.29, "standard_charge_percentage": 85.0000, "estimated_amount": 5847, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2889.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5159.38, "standard_charge_percentage": 75.0000, "estimated_amount": 5159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2744.79, "standard_charge_percentage": 42.0000, "estimated_amount": 2744, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3439.59, "standard_charge_percentage": 50.0000, "estimated_amount": 3439, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6019.27, "standard_charge_percentage": 87.5000, "estimated_amount": 6019, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6191.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2802.57, "standard_charge_percentage": 42.0000, "estimated_amount": 2802, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2802.57, "standard_charge_percentage": 42.0000, "estimated_amount": 2802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1498, "estimated_amount": 1498, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4127.5, "standard_charge_percentage": 60.0000, "estimated_amount": 4127, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4815.42, "standard_charge_percentage": 70.0000, "estimated_amount": 4815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4815.42, "standard_charge_percentage": 70.0000, "estimated_amount": 4815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2197.96, "estimated_amount": 2197, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2860.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2860, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2802.57, "standard_charge_percentage": 42.0000, "estimated_amount": 2802, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2889.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5503.34, "standard_charge_percentage": 80.0000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6191.25, "standard_charge_percentage": 90.0000, "estimated_amount": 6191, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2802.57, "standard_charge_percentage": 42.0000, "estimated_amount": 2802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4815.42, "standard_charge_percentage": 70.0000, "estimated_amount": 4815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" }]}]} , { "description": "Exc Forearm Les Sc < 3 Cm", "code_information": [ { "code": "25075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.5, "discounted_cash": 2297,"minimum": 1045.33,"maximum": 6234.38,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1968.75, "standard_charge_percentage": 30.0000, "estimated_amount": 1968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1884.27, "estimated_amount": 1884, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 5578.13, "standard_charge_percentage": 85.0000, "estimated_amount": 5578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 5742.19, "standard_charge_percentage": 87.5000, "estimated_amount": 5742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6234.38, "standard_charge_percentage": 95.0000, "estimated_amount": 6234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2728.69, "standard_charge_percentage": 42.0000, "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1855.99, "estimated_amount": 1855, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1150, "estimated_amount": 1150, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3204.47, "standard_charge_percentage": 48.8300, "estimated_amount": 3204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1802.96, "estimated_amount": 1802, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 1494.02, "estimated_amount": 1494, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1571.41, "estimated_amount": 1571, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4921.88, "standard_charge_percentage": 75.0000, "estimated_amount": 4921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3937.5, "standard_charge_percentage": 60.0000, "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2756.25, "standard_charge_percentage": 42.0000, "estimated_amount": 2756, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5510, "estimated_amount": 5510, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2474.65, "estimated_amount": 2474, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1591.38, "estimated_amount": 1591, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3281.25, "standard_charge_percentage": 50.0000, "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 5906.25, "standard_charge_percentage": 90.0000, "estimated_amount": 5906, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 4593.75, "standard_charge_percentage": 70.0000, "estimated_amount": 4593, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2618.44, "standard_charge_percentage": 42.0000, "estimated_amount": 2618, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1767.61, "estimated_amount": 1767, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2673.56, "standard_charge_percentage": 42.0000, "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5250, "standard_charge_percentage": 80.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2680.49, "estimated_amount": 2680, "methodology": "case rate" }]}]} , { "description": "Hc Excision Ganglion Wrist, Primary", "code_information": [ { "code": "25111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7276.3, "discounted_cash": 2269,"minimum": 1216,"maximum": 6912.48,"payers_information":[{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2964.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2964, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 6184.85, "standard_charge_percentage": 85.0000, "estimated_amount": 6184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 3025.49, "standard_charge_percentage": 42.0000, "estimated_amount": 3025, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2758.17, "estimated_amount": 2758, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 6548.67, "standard_charge_percentage": 90.0000, "estimated_amount": 6548, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 3056.05, "standard_charge_percentage": 42.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2964.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2964, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2903.24, "standard_charge_percentage": 42.0000, "estimated_amount": 2903, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 4365.78, "standard_charge_percentage": 60.0000, "estimated_amount": 4365, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2964.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2964, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 6366.76, "standard_charge_percentage": 87.5000, "estimated_amount": 6366, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 5093.41, "standard_charge_percentage": 70.0000, "estimated_amount": 5093, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 3056.05, "standard_charge_percentage": 42.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 3553.02, "standard_charge_percentage": 48.8300, "estimated_amount": 3553, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 6912.48, "standard_charge_percentage": 95.0000, "estimated_amount": 6912, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 3638.15, "standard_charge_percentage": 50.0000, "estimated_amount": 3638, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 5821.04, "standard_charge_percentage": 80.0000, "estimated_amount": 5821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2964.36, "standard_charge_percentage": 42.0000, "estimated_amount": 2964, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 5093.41, "standard_charge_percentage": 70.0000, "estimated_amount": 5093, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 5093.41, "standard_charge_percentage": 70.0000, "estimated_amount": 5093, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 6548.67, "standard_charge_percentage": 90.0000, "estimated_amount": 6548, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2182.89, "standard_charge_percentage": 30.0000, "estimated_amount": 2182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2046.94, "estimated_amount": 2046, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2046.94, "estimated_amount": 2046, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2903.24, "standard_charge_percentage": 42.0000, "estimated_amount": 2903, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1637.5, "estimated_amount": 1637, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 5457.23, "standard_charge_percentage": 75.0000, "estimated_amount": 5457, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 6548.67, "standard_charge_percentage": 90.0000, "estimated_amount": 6548, "methodology": "percent of total billed charges" }]}]} , { "description": "Reremove wrist tendon lesion", "code_information": [ { "code": "25112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10362.5, "discounted_cash": 2269,"minimum": 1216,"maximum": 9844.38,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 8290, "standard_charge_percentage": 80.0000, "estimated_amount": 8290, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 4352.25, "standard_charge_percentage": 42.0000, "estimated_amount": 4352, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 4308.73, "standard_charge_percentage": 42.0000, "estimated_amount": 4308, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5181.25, "standard_charge_percentage": 50.0000, "estimated_amount": 5181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 8290, "standard_charge_percentage": 80.0000, "estimated_amount": 8290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 4221.68, "standard_charge_percentage": 42.0000, "estimated_amount": 4221, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 2046.94, "estimated_amount": 2046, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 8290, "standard_charge_percentage": 80.0000, "estimated_amount": 8290, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1216, "estimated_amount": 1216, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 8290, "standard_charge_percentage": 80.0000, "estimated_amount": 8290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6217.5, "standard_charge_percentage": 60.0000, "estimated_amount": 6217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 7253.75, "standard_charge_percentage": 70.0000, "estimated_amount": 7253, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 4221.68, "standard_charge_percentage": 42.0000, "estimated_amount": 4221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8290, "standard_charge_percentage": 80.0000, "estimated_amount": 8290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 8290, "standard_charge_percentage": 80.0000, "estimated_amount": 8290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 8808.13, "standard_charge_percentage": 85.0000, "estimated_amount": 8808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 2046.94, "estimated_amount": 2046, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 4134.64, "standard_charge_percentage": 42.0000, "estimated_amount": 4134, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 4352.25, "standard_charge_percentage": 42.0000, "estimated_amount": 4352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3108.75, "standard_charge_percentage": 30.0000, "estimated_amount": 3108, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1637.5, "estimated_amount": 1637, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 9067.19, "standard_charge_percentage": 87.5000, "estimated_amount": 9067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 7253.75, "standard_charge_percentage": 70.0000, "estimated_amount": 7253, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 4221.68, "standard_charge_percentage": 42.0000, "estimated_amount": 4221, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 9326.25, "standard_charge_percentage": 90.0000, "estimated_amount": 9326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5060.01, "standard_charge_percentage": 48.8300, "estimated_amount": 5060, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 5685, "estimated_amount": 5685, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 9326.25, "standard_charge_percentage": 90.0000, "estimated_amount": 9326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 4134.64, "standard_charge_percentage": 42.0000, "estimated_amount": 4134, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 9326.25, "standard_charge_percentage": 90.0000, "estimated_amount": 9326, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 8290, "standard_charge_percentage": 80.0000, "estimated_amount": 8290, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2758.17, "estimated_amount": 2758, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 7771.88, "standard_charge_percentage": 75.0000, "estimated_amount": 7771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 8290, "standard_charge_percentage": 80.0000, "estimated_amount": 8290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8290, "standard_charge_percentage": 80.0000, "estimated_amount": 8290, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 8290, "standard_charge_percentage": 80.0000, "estimated_amount": 8290, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 4221.68, "standard_charge_percentage": 42.0000, "estimated_amount": 4221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 7253.75, "standard_charge_percentage": 70.0000, "estimated_amount": 7253, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 9844.38, "standard_charge_percentage": 95.0000, "estimated_amount": 9844, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Inj For Wrist X-Ray", "code_information": [ { "code": "25246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350,"minimum": 69.83,"maximum": 350,"payers_information":[{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 280, "standard_charge_percentage": 80.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 245, "standard_charge_percentage": 70.0000, "estimated_amount": 245, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 280, "standard_charge_percentage": 80.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 350, "estimated_amount": 350, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 175, "standard_charge_percentage": 50.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 73.5, "standard_charge_percentage": 21.0000, "estimated_amount": 73, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 280, "standard_charge_percentage": 80.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 245, "standard_charge_percentage": 70.0000, "estimated_amount": 245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 280, "standard_charge_percentage": 80.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 69.83, "standard_charge_percentage": 21.0000, "estimated_amount": 69, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 350, "estimated_amount": 350, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 280, "standard_charge_percentage": 80.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 315, "standard_charge_percentage": 90.0000, "estimated_amount": 315, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 245, "standard_charge_percentage": 70.0000, "estimated_amount": 245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 280, "standard_charge_percentage": 80.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 280, "standard_charge_percentage": 80.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 73.5, "standard_charge_percentage": 21.0000, "estimated_amount": 73, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 71.3, "standard_charge_percentage": 21.0000, "estimated_amount": 71, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 315, "standard_charge_percentage": 90.0000, "estimated_amount": 315, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 105, "standard_charge_percentage": 30.0000, "estimated_amount": 105, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 72.77, "standard_charge_percentage": 21.0000, "estimated_amount": 72, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 306.25, "standard_charge_percentage": 87.5000, "estimated_amount": 306, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 262.5, "standard_charge_percentage": 75.0000, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 280, "standard_charge_percentage": 80.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 71.3, "standard_charge_percentage": 21.0000, "estimated_amount": 71, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 69.83, "standard_charge_percentage": 21.0000, "estimated_amount": 69, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 332.5, "standard_charge_percentage": 95.0000, "estimated_amount": 332, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 315, "standard_charge_percentage": 90.0000, "estimated_amount": 315, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 210, "standard_charge_percentage": 60.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 71.3, "standard_charge_percentage": 21.0000, "estimated_amount": 71, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 280, "standard_charge_percentage": 80.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 71.3, "standard_charge_percentage": 21.0000, "estimated_amount": 71, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 297.5, "standard_charge_percentage": 85.0000, "estimated_amount": 297, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 280, "standard_charge_percentage": 80.0000, "estimated_amount": 280, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Radial Shaft Fx Wo Amnip", "code_information": [ { "code": "25500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 861.65, "discounted_cash": 340,"minimum": 112.04,"maximum": 861.65,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 420.74, "standard_charge_percentage": 48.8300, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 646.24, "standard_charge_percentage": 75.0000, "estimated_amount": 646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 732.4, "standard_charge_percentage": 85.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 516.99, "standard_charge_percentage": 60.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 258.5, "standard_charge_percentage": 30.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 179.14, "standard_charge_percentage": 21.0000, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 818.57, "standard_charge_percentage": 95.0000, "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 430.82, "standard_charge_percentage": 50.0000, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 753.94, "standard_charge_percentage": 87.5000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Radial Shaft Fx W Manip", "code_information": [ { "code": "25505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 519.96,"maximum": 5208.14,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Radial Shaft Fx & Sital Disloc", "code_information": [ { "code": "25520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 282,"maximum": 5208.14,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Ulna Shaft Fx Wo Amnip", "code_information": [ { "code": "25530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 861.65, "discounted_cash": 340,"minimum": 112.04,"maximum": 861.65,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 420.74, "standard_charge_percentage": 48.8300, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 258.5, "standard_charge_percentage": 30.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 732.4, "standard_charge_percentage": 85.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 753.94, "standard_charge_percentage": 87.5000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 818.57, "standard_charge_percentage": 95.0000, "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 646.24, "standard_charge_percentage": 75.0000, "estimated_amount": 646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 516.99, "standard_charge_percentage": 60.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 430.82, "standard_charge_percentage": 50.0000, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 179.14, "standard_charge_percentage": 21.0000, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Ulna Shaft Fx W Manip", "code_information": [ { "code": "25535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1187.5, "discounted_cash": 340,"minimum": 150.15,"maximum": 1187.5,"payers_information":[{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 579.86, "standard_charge_percentage": 48.8300, "estimated_amount": 579, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 890.63, "standard_charge_percentage": 75.0000, "estimated_amount": 890, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 450.13, "estimated_amount": 450, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1009.38, "standard_charge_percentage": 85.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 712.5, "standard_charge_percentage": 60.0000, "estimated_amount": 712, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1039.06, "standard_charge_percentage": 87.5000, "estimated_amount": 1039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 267.24, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 356.25, "standard_charge_percentage": 30.0000, "estimated_amount": 356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1187.5, "estimated_amount": 1187, "methodology": "case rate" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 246.88, "standard_charge_percentage": 21.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 593.75, "standard_charge_percentage": 50.0000, "estimated_amount": 593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1128.13, "standard_charge_percentage": 95.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Rad/Ulna Shaft Fx Wo Manip", "code_information": [ { "code": "25560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 653, "discounted_cash": 340,"minimum": 112.04,"maximum": 653,"payers_information":[{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 620.35, "standard_charge_percentage": 95.0000, "estimated_amount": 620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 587.7, "standard_charge_percentage": 90.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 587.7, "standard_charge_percentage": 90.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 137.13, "standard_charge_percentage": 21.0000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 653, "estimated_amount": 653, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 318.86, "standard_charge_percentage": 48.8300, "estimated_amount": 318, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 571.38, "standard_charge_percentage": 87.5000, "estimated_amount": 571, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 457.1, "standard_charge_percentage": 70.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 137.13, "standard_charge_percentage": 21.0000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 555.05, "standard_charge_percentage": 85.0000, "estimated_amount": 555, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 135.76, "standard_charge_percentage": 21.0000, "estimated_amount": 135, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 130.27, "standard_charge_percentage": 21.0000, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 457.1, "standard_charge_percentage": 70.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 587.7, "standard_charge_percentage": 90.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 195.9, "standard_charge_percentage": 30.0000, "estimated_amount": 195, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 457.1, "standard_charge_percentage": 70.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 653, "estimated_amount": 653, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 489.75, "standard_charge_percentage": 75.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 326.5, "standard_charge_percentage": 50.0000, "estimated_amount": 326, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 391.8, "standard_charge_percentage": 60.0000, "estimated_amount": 391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 130.27, "standard_charge_percentage": 21.0000, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat fracture radius & ulna", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 282,"maximum": 5208.14,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Distl Rad/Ulna Fx Wo Manip", "code_information": [ { "code": "25600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 653, "discounted_cash": 340,"minimum": 112.04,"maximum": 653,"payers_information":[{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 137.13, "standard_charge_percentage": 21.0000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 195.9, "standard_charge_percentage": 30.0000, "estimated_amount": 195, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 555.05, "standard_charge_percentage": 85.0000, "estimated_amount": 555, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 326.5, "standard_charge_percentage": 50.0000, "estimated_amount": 326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 653, "estimated_amount": 653, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 457.1, "standard_charge_percentage": 70.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 620.35, "standard_charge_percentage": 95.0000, "estimated_amount": 620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 653, "estimated_amount": 653, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 267.24, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 489.75, "standard_charge_percentage": 75.0000, "estimated_amount": 489, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 450.13, "estimated_amount": 450, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 130.27, "standard_charge_percentage": 21.0000, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 587.7, "standard_charge_percentage": 90.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 587.7, "standard_charge_percentage": 90.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 135.76, "standard_charge_percentage": 21.0000, "estimated_amount": 135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 391.8, "standard_charge_percentage": 60.0000, "estimated_amount": 391, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 130.27, "standard_charge_percentage": 21.0000, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 587.7, "standard_charge_percentage": 90.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 457.1, "standard_charge_percentage": 70.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 137.13, "standard_charge_percentage": 21.0000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 318.86, "standard_charge_percentage": 48.8300, "estimated_amount": 318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 571.38, "standard_charge_percentage": 87.5000, "estimated_amount": 571, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 133.02, "standard_charge_percentage": 21.0000, "estimated_amount": 133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 522.4, "standard_charge_percentage": 80.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 457.1, "standard_charge_percentage": 70.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Distl Rad/Ulna Fx W Manip", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1096.45, "discounted_cash": 2269,"minimum": 218.74,"maximum": 1096.45,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 877.16, "standard_charge_percentage": 80.0000, "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 767.51, "standard_charge_percentage": 70.0000, "estimated_amount": 767, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 230.25, "standard_charge_percentage": 21.0000, "estimated_amount": 230, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 931.98, "standard_charge_percentage": 85.0000, "estimated_amount": 931, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 657.87, "standard_charge_percentage": 60.0000, "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 877.16, "standard_charge_percentage": 80.0000, "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 218.74, "standard_charge_percentage": 21.0000, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 877.16, "standard_charge_percentage": 80.0000, "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 535.4, "standard_charge_percentage": 48.8300, "estimated_amount": 535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 877.16, "standard_charge_percentage": 80.0000, "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 223.35, "standard_charge_percentage": 21.0000, "estimated_amount": 223, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 877.16, "standard_charge_percentage": 80.0000, "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 877.16, "standard_charge_percentage": 80.0000, "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 218.74, "standard_charge_percentage": 21.0000, "estimated_amount": 218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 223.35, "standard_charge_percentage": 21.0000, "estimated_amount": 223, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 877.16, "standard_charge_percentage": 80.0000, "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 548.23, "standard_charge_percentage": 50.0000, "estimated_amount": 548, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 986.8, "standard_charge_percentage": 90.0000, "estimated_amount": 986, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 223.35, "standard_charge_percentage": 21.0000, "estimated_amount": 223, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 986.8, "standard_charge_percentage": 90.0000, "estimated_amount": 986, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "case rate" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1041.63, "standard_charge_percentage": 95.0000, "estimated_amount": 1041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 877.16, "standard_charge_percentage": 80.0000, "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 877.16, "standard_charge_percentage": 80.0000, "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 230.25, "standard_charge_percentage": 21.0000, "estimated_amount": 230, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 959.39, "standard_charge_percentage": 87.5000, "estimated_amount": 959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 767.51, "standard_charge_percentage": 70.0000, "estimated_amount": 767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 328.94, "standard_charge_percentage": 30.0000, "estimated_amount": 328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 223.35, "standard_charge_percentage": 21.0000, "estimated_amount": 223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 822.34, "standard_charge_percentage": 75.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 986.8, "standard_charge_percentage": 90.0000, "estimated_amount": 986, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 877.16, "standard_charge_percentage": 80.0000, "estimated_amount": 877, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 227.95, "standard_charge_percentage": 21.0000, "estimated_amount": 227, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 767.51, "standard_charge_percentage": 70.0000, "estimated_amount": 767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1096.45, "estimated_amount": 1096, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Navicular Fx Wo Manip", "code_information": [ { "code": "25622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 861.65, "discounted_cash": 340,"minimum": 112.04,"maximum": 861.65,"payers_information":[{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 732.4, "standard_charge_percentage": 85.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 420.74, "standard_charge_percentage": 48.8300, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 753.94, "standard_charge_percentage": 87.5000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 818.57, "standard_charge_percentage": 95.0000, "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 179.14, "standard_charge_percentage": 21.0000, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 646.24, "standard_charge_percentage": 75.0000, "estimated_amount": 646, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 258.5, "standard_charge_percentage": 30.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 430.82, "standard_charge_percentage": 50.0000, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 516.99, "standard_charge_percentage": 60.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Navicular Fx W Manip", "code_information": [ { "code": "25624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 577.77,"maximum": 5208.14,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1045.33, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 4082, "estimated_amount": 4082, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 596, "estimated_amount": 596, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 2271.1, "estimated_amount": 2271, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" }]}]} , { "description": "Hc Open Tx Carpal Scaphoid Navicular Fracture", "code_information": [ { "code": "25628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11978, "discounted_cash": 10131,"minimum": 1383,"maximum": 11379.1,"payers_information":[{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 8183.2, "estimated_amount": 8183, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 2439.92, "standard_charge_percentage": 21.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 4028.42, "estimated_amount": 4028, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3593.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 10480.8, "standard_charge_percentage": 87.5000, "estimated_amount": 10480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 10910.9, "estimated_amount": 10910, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 8983.5, "standard_charge_percentage": 75.0000, "estimated_amount": 8983, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 2439.92, "standard_charge_percentage": 21.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 7949.39, "estimated_amount": 7949, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1847, "estimated_amount": 1847, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 4540.39, "estimated_amount": 4540, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 2389.61, "standard_charge_percentage": 21.0000, "estimated_amount": 2389, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 11379.1, "standard_charge_percentage": 95.0000, "estimated_amount": 11379, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 10181.3, "standard_charge_percentage": 85.0000, "estimated_amount": 10181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 8307.89, "estimated_amount": 8307, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 2389.61, "standard_charge_percentage": 21.0000, "estimated_amount": 2389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 5848.86, "standard_charge_percentage": 48.8300, "estimated_amount": 5848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 4028.42, "estimated_amount": 4028, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 2490.23, "standard_charge_percentage": 21.0000, "estimated_amount": 2490, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 2515.38, "standard_charge_percentage": 21.0000, "estimated_amount": 2515, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 1383, "estimated_amount": 1383, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 2515.38, "standard_charge_percentage": 21.0000, "estimated_amount": 2515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 2439.92, "standard_charge_percentage": 21.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7793.52, "estimated_amount": 7793, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 5989, "standard_charge_percentage": 50.0000, "estimated_amount": 5989, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 2695.59, "estimated_amount": 2695, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 6315, "estimated_amount": 6315, "methodology": "case rate" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 1792.53, "estimated_amount": 1792, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 2439.92, "standard_charge_percentage": 21.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7186.8, "standard_charge_percentage": 60.0000, "estimated_amount": 7186, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 3332.53, "estimated_amount": 3332, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 6928.44, "estimated_amount": 6928, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 9582.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9582, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 10780.2, "standard_charge_percentage": 90.0000, "estimated_amount": 10780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 8384.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8384, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat wrist bone fracture", "code_information": [ { "code": "25630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 861.65, "discounted_cash": 340,"minimum": 112.04,"maximum": 861.65,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 179.14, "standard_charge_percentage": 21.0000, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 180.95, "standard_charge_percentage": 21.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 430.82, "standard_charge_percentage": 50.0000, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 646.24, "standard_charge_percentage": 75.0000, "estimated_amount": 646, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 420.74, "standard_charge_percentage": 48.8300, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 818.57, "standard_charge_percentage": 95.0000, "estimated_amount": 818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 258.5, "standard_charge_percentage": 30.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 732.4, "standard_charge_percentage": 85.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 861.65, "estimated_amount": 861, "methodology": "case rate" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 193.91, "estimated_amount": 193, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 775.49, "standard_charge_percentage": 90.0000, "estimated_amount": 775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 753.94, "standard_charge_percentage": 87.5000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 326.62, "estimated_amount": 326, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 171.9, "standard_charge_percentage": 21.0000, "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 175.52, "standard_charge_percentage": 21.0000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 516.99, "standard_charge_percentage": 60.0000, "estimated_amount": 516, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 689.32, "standard_charge_percentage": 80.0000, "estimated_amount": 689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 603.15, "standard_charge_percentage": 70.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat wrist bone fracture", "code_information": [ { "code": "25635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5482.25, "discounted_cash": 2269,"minimum": 282,"maximum": 5208.14,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 1552.18, "estimated_amount": 1552, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3289.35, "standard_charge_percentage": 60.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 1233.76, "estimated_amount": 1233, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 1861.21, "estimated_amount": 1861, "methodology": "fee schedule" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 50.0000, "estimated_amount": 2741, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 4659.91, "standard_charge_percentage": 85.0000, "estimated_amount": 4659, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 4796.97, "standard_charge_percentage": 87.5000, "estimated_amount": 4796, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 4111.69, "standard_charge_percentage": 75.0000, "estimated_amount": 4111, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1644.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 1151.27, "standard_charge_percentage": 21.0000, "estimated_amount": 1151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 1780.9, "estimated_amount": 1780, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 2078.12, "estimated_amount": 2078, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 577.77, "estimated_amount": 577, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 2676.98, "standard_charge_percentage": 48.8300, "estimated_amount": 2676, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 3774, "estimated_amount": 3774, "methodology": "case rate" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 1093.71, "standard_charge_percentage": 21.0000, "estimated_amount": 1093, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 1116.73, "standard_charge_percentage": 21.0000, "estimated_amount": 1116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 2444.37, "estimated_amount": 2444, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 5208.14, "standard_charge_percentage": 95.0000, "estimated_amount": 5208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 1139.76, "standard_charge_percentage": 21.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 1833.28, "estimated_amount": 1833, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 4385.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4385, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 3837.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 4934.02, "standard_charge_percentage": 90.0000, "estimated_amount": 4934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 1745.98, "estimated_amount": 1745, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Ulna Styloid Fx", "code_information": [ { "code": "25650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1187.5, "discounted_cash": 340,"minimum": 112.04,"maximum": 1187.5,"payers_information":[{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 450.13, "estimated_amount": 450, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1009.38, "standard_charge_percentage": 85.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1128.13, "standard_charge_percentage": 95.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 712.5, "standard_charge_percentage": 60.0000, "estimated_amount": 712, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 1187.5, "estimated_amount": 1187, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 246.88, "standard_charge_percentage": 21.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 255.54, "estimated_amount": 255, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 267.24, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 593.75, "standard_charge_percentage": 50.0000, "estimated_amount": 593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 356.25, "standard_charge_percentage": 30.0000, "estimated_amount": 356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 112.04, "estimated_amount": 112, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 579.86, "standard_charge_percentage": 48.8300, "estimated_amount": 579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 890.63, "standard_charge_percentage": 75.0000, "estimated_amount": 890, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1187.5, "estimated_amount": 1187, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1039.06, "standard_charge_percentage": 87.5000, "estimated_amount": 1039, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat wrist dislocation", "code_information": [ { "code": "25660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1187.5, "discounted_cash": 340,"minimum": 150.15,"maximum": 1187.5,"payers_information":[{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1039.06, "standard_charge_percentage": 87.5000, "estimated_amount": 1039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1128.13, "standard_charge_percentage": 95.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "STAR HEALTHCARE NETWORK", "plan_name": "STAR HEALTHCARE NETWORK Commercial ", "standard_charge_dollar": 1009.38, "standard_charge_percentage": 85.0000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 712.5, "standard_charge_percentage": 60.0000, "estimated_amount": 712, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1187.5, "estimated_amount": 1187, "methodology": "case rate" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 593.75, "standard_charge_percentage": 50.0000, "estimated_amount": 593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 267.24, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 890.63, "standard_charge_percentage": 75.0000, "estimated_amount": 890, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 356.25, "standard_charge_percentage": 30.0000, "estimated_amount": 356, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 450.13, "estimated_amount": 450, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 579.86, "standard_charge_percentage": 48.8300, "estimated_amount": 579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 246.88, "standard_charge_percentage": 21.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT WRIST DISLOCATION", "code_information": [ { "code": "25675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1187.5, "discounted_cash": 340,"minimum": 150.15,"maximum": 1187.5,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Commercial", "standard_charge_dollar": 278.96, "estimated_amount": 278, "methodology": "fee schedule" } ,{ "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Commercial", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Commercial", "standard_charge_dollar": 1039.06, "standard_charge_percentage": 87.5000, "estimated_amount": 1039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercials - 80% of BC", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare Advantage", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 356.25, "standard_charge_percentage": 30.0000, "estimated_amount": 356, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Comm & Ins Exchange", "standard_charge_dollar": 450.13, "estimated_amount": 450, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid ", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicaid", "standard_charge_dollar": 282, "estimated_amount": 282, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Common Wellthcare Alliance", "plan_name": "Commonwealth Care Alliance Medicare One Care", "standard_charge_dollar": 274.77, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts TMC", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry First Health", "plan_name": "Coventry First Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS & INDEPENDENT MEDICAL SYSTEMS", "standard_charge_dollar": 593.75, "standard_charge_percentage": 50.0000, "estimated_amount": 593, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Auto", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "standard_charge_dollar": 249.38, "standard_charge_percentage": 21.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "PROVIDER SELECT, INC.", "plan_name": "PROVIDER SELECT, INC Workers Compensation", "standard_charge_dollar": 246.88, "standard_charge_percentage": 21.0000, "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Commercial (Primary & Supplemental)", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid - 95 Percent", "standard_charge_dollar": 150.15, "estimated_amount": 150, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "standard_charge_dollar": 266.92, "estimated_amount": 266, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Commercial", "standard_charge_dollar": 1128.13, "standard_charge_percentage": 95.0000, "estimated_amount": 1128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid", "standard_charge_dollar": 939.58, "estimated_amount": 939, "methodology": "case rate" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "standard_charge_dollar": 1187.5, "estimated_amount": 1187, "methodology": "case rate" } ,{ "payer_name": "BCBS Of RI", "plan_name": "BCBS RI Medicare", "standard_charge_dollar": 267.24, "estimated_amount": 267, "methodology": "case rate" } ,{ "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicaid", "standard_charge_dollar": 922, "estimated_amount": 922, "methodology": "case rate" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Auto ", "standard_charge_dollar": 950, "standard_charge_percentage": 80.0000, "estimated_amount": 950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Integrity", "standard_charge_dollar": 232.64, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Medicaid - MassHealth Mass subsidized", "standard_charge_dollar": 519.96, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "Neighborhood Health Plan", "plan_name": "Neighborhood Health Plan Medicare", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Accident & Health", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "standard_charge_dollar": 366.37, "estimated_amount": 366, "methodology": "fee schedule" } ,{ "payer_name": "PRIME HEALTH SERVICES, INC.", "plan_name": "PRIME HEALTH SERVICES, INC Workers Compensation", "standard_charge_dollar": 241.89, "standard_charge_percentage": 21.0000, "estimated_amount": 241, "methodology": "percent of total billed charges" } ,{ "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "THREE RIVERS PROVIDER NETWORK Auto", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Health Plan Mass Duals", "standard_charge_dollar": 261.69, "estimated_amount": 261, "methodology": "fee schedule" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts Commercial", "standard_charge_dollar": 579.86, "standard_charge_percentage": 48.8300, "estimated_amount": 579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zelis (FKA) Stratose", "plan_name": "Zelis (FKA) Stratose Auto", "standard_charge_dollar": 890.63, "standard_charge_percentage": 75.0000, "estimated_amount": 890, "methodology": "percent of total billed charges" } ,{ "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "standard_charge_dollar": 236.91, "standard_charge_percentage": 21.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) ", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Commercial", "standard_charge_dollar": 1068.75, "standard_charge_percentage": 90.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "HARVARD PILGRIM HEALTHCARE", "plan_name": "HARVARD PILGRIM HEALTHCARE", "standard_charge_dollar": 831.25, "standard_charge_percentage": 70.0000, "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tufts Health Plan", "plan_name": "Tufts M