{
  "hospital_name": "Elkhorn Valley Rehabilitation Hospital",
  "last_updated_on": "2026-01-01",
  "version": "2.0.0",
  "hospital_location": [
    "Elkhorn Valley Rehabilitation Hospital"
  ],
  "hospital_address": [
    "5715 E 2nd St, Casper, WY 82609"
  ],
  "license_information": {
    "state": "WY"
  },
  "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
  },
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    {
      "description": "Stroke M >=72.50- Tier None",
      "code_information": [
        {
          "code": "A0101",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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        {
          "setting": "inpatient",
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    {
      "description": "Stroke M >=50.50 and M <63.50- Tier None",
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        {
          "code": "A0103",
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        {
          "setting": "inpatient",
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        {
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    {
      "description": "Traumatic brain injury M >=73.50- Tier None",
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        {
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      ],
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        {
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    {
      "description": "Traumatic brain injury M >=49.50 and M <61.50- Tier None",
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    {
      "description": "Traumatic brain injury M >=35.50 and M <49.50- Tier None",
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          "code": "A0204",
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 27959.95,
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 27959.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 27959.95,
              "methodology": "fee schedule"
            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27959.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 27959.95,
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          ],
          "minimum": 27400.75,
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      ]
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      "description": "Laboratory - General Classification",
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        {
          "code": "0300",
          "type": "RC"
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      ],
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          "setting": "outpatient",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Cigna Health and Life Insurance Company",
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              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 52827,
              "methodology": "fee schedule"
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            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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      ]
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      "description": "Laboratory - Chemistry",
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        {
          "code": "0301",
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      ],
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice of the Midwest",
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            },
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              "payer_name": "Wise Provider Networks",
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            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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            },
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              "payer_name": "InterWest Health",
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            {
              "payer_name": "Cofinity",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1958.28,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1958.28,
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          ],
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      ]
    },
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      "description": "Respiratory Services - General Classification",
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        {
          "code": "0410",
          "type": "RC"
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      ],
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          "setting": "outpatient",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Wise Provider Networks",
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            },
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              "payer_name": "Cigna Health and Life Insurance Company",
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            },
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              "payer_name": "InterWest Health",
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              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 2990,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 2990,
              "methodology": "fee schedule"
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          ],
          "minimum": 120.7,
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      ]
    },
    {
      "description": "Physical Therapy - General Classification",
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          "code": "0420",
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      ],
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          "setting": "outpatient",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "percent of total billed charges"
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "First Choice of the Midwest",
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              "payer_name": "Wise Provider Networks",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_dollar": 120,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Workers' Compensation Program",
              "standard_charge_dollar": 120,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Network Lease",
              "standard_charge_dollar": 120,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Commercial Insured/Self-Insured",
              "standard_charge_dollar": 120,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
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              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 511,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
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            }
          ],
          "minimum": 70,
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      ]
    },
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      "description": "Physical Therapy - Visit Charge",
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        {
          "code": "0421",
          "type": "RC"
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      ],
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          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            }
          ],
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      ]
    },
    {
      "description": "Physical Therapy - Hourly Charge",
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        {
          "code": "0422",
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      ],
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          "setting": "outpatient",
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            },
            {
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            }
          ],
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        }
      ]
    },
    {
      "description": "Physical Therapy - Group Rate",
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        {
          "code": "0423",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            }
          ],
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        }
      ]
    },
    {
      "description": "Physical Therapy - Evaluation or Re-evaluation",
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        {
          "code": "0424",
          "type": "RC"
        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 221,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
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              "estimated_amount": 221,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_dollar": 120,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 70,
          "maximum": 260
        }
      ]
    },
    {
      "description": "Physical Therapy - Other",
      "code_information": [
        {
          "code": "0429",
          "type": "RC"
        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Automobile Insurance Compensation Program",
              "standard_charge_dollar": 250,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Workers' Compensation Program",
              "standard_charge_dollar": 250,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Network Lease",
              "standard_charge_dollar": 250,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Commercial Insured/Self-Insured",
              "standard_charge_dollar": 250,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Commercial",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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    },
    {
      "description": "Occupational Therapy - General Classification",
      "code_information": [
        {
          "code": "0430",
          "type": "RC"
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          "setting": "outpatient",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "percent of total billed charges"
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              "payer_name": "United Healthcare (UHC)",
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            {
              "payer_name": "United Healthcare (UHC)",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "Wise Provider Networks",
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            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "Cigna Health and Life Insurance Company",
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            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Automobile Insurance Compensation Program",
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            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
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            {
              "payer_name": "Coventry Health Care",
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              "payer_name": "United Healthcare (UHC)",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
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            {
              "payer_name": "Cofinity",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 511,
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            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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          ],
          "minimum": 70,
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    },
    {
      "description": "Occupational Therapy - Visit Charge",
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        {
          "code": "0431",
          "type": "RC"
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      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Occupational Therapy - Hourly Charge",
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        {
          "code": "0432",
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          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Occupational Therapy - Group Rate",
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        {
          "code": "0433",
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      ],
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          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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            },
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "United Healthcare (UHC)",
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          ],
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      ]
    },
    {
      "description": "Occupational Therapy - Evaluation or Reevaluation",
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        {
          "code": "0434",
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        }
      ],
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        {
          "setting": "outpatient",
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            },
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              "payer_name": "Wise Provider Networks",
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              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Cigna Health and Life Insurance Company",
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            },
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              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "InterWest Health",
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            {
              "payer_name": "Cofinity",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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          ],
          "minimum": 70,
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      ]
    },
    {
      "description": "Occupational Therapy - Other",
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        {
          "code": "0439",
          "type": "RC"
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      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
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              "payer_name": "United Healthcare (UHC)",
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          ],
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      ]
    },
    {
      "description": "Speech Therapy - Language Pathology - General Classification",
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        {
          "code": "0440",
          "type": "RC"
        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "percent of total billed charges"
            },
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            },
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              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Commercial Insured/Self-Insured",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 274,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 274,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 45.5,
          "maximum": 274
        }
      ]
    },
    {
      "description": "Speech Therapy - Language Pathology - Visit Charge",
      "code_information": [
        {
          "code": "0441",
          "type": "RC"
        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HMO Select",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Individul Exchange (ACA)",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 70,
          "maximum": 140
        }
      ]
    },
    {
      "description": "Speech Therapy - Language Pathology - Hourly Charge",
      "code_information": [
        {
          "code": "0442",
          "type": "RC"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "PPO",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Indemnity ",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "HMO",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Advantage Networks",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "National POS (NPOS)",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HMO Premier",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HMO Select",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Network",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Commercial",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 70,
          "maximum": 140
        }
      ]
    },
    {
      "description": "Speech Therapy - Language Pathology - Group Rate",
      "code_information": [
        {
          "code": "0443",
          "type": "RC"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "PPO",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "HMO",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Advantage Networks",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "National POS (NPOS)",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HMO Premier",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HMO Select",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Network",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Commercial",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Individul Exchange (ACA)",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 70,
          "maximum": 140
        }
      ]
    },
    {
      "description": "Speech Therapy - Language Pathology - Evaluation or Reevaluation",
      "code_information": [
        {
          "code": "0444",
          "type": "RC"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "PPO",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "HMO",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 234,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 182,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "National POS (NPOS)",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HMO Premier",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HMO Select",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Network",
              "standard_charge_dollar": 70,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 221,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Commercial",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Individul Exchange (ACA)",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 234,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 325,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 325,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 70,
          "maximum": 325
        }
      ]
    },
    {
      "description": "Speech Therapy - Language Pathology - Other",
      "code_information": [
        {
          "code": "0449",
          "type": "RC"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "PPO",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Indemnity ",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "HMO",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Commercial",
              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_dollar": 140,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 140,
          "maximum": 140
        }
      ]
    },
    {
      "description": "Fna bx w/us gdn 1st les",
      "code_information": [
        {
          "code": "10005",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 68.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 68.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 68.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 68.84,
              "methodology": "fee schedule"
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          ],
          "minimum": 68.84,
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      ]
    },
    {
      "description": "I&d abscess simple/single",
      "code_information": [
        {
          "code": "10060",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 103.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 103.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 103.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 103.71,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 103.71,
          "maximum": 103.71
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      ]
    },
    {
      "description": "I&d abscess comp/multiple",
      "code_information": [
        {
          "code": "10061",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 177.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 177.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 177.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 177.31,
              "methodology": "fee schedule"
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          ],
          "minimum": 177.31,
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      ]
    },
    {
      "description": "Dbrdmt subq tiss each addl",
      "code_information": [
        {
          "code": "11045",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 23.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 23.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 23.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23.35,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23.35,
          "maximum": 23.35
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      ]
    },
    {
      "description": "Exc tr-ext b9+marg >4.0 cm",
      "code_information": [
        {
          "code": "11406",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 238.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 238.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 238.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 238.81,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 238.81,
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      ]
    },
    {
      "description": "Exc h-f-nk-sp b9+marg 1.1-2",
      "code_information": [
        {
          "code": "11422",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 132.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 132.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 132.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 132.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 132.47,
          "maximum": 132.47
        }
      ]
    },
    {
      "description": "Rpr s/n/ax/gen/trnk 2.5cm/<",
      "code_information": [
        {
          "code": "12001",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.99,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 41.99,
          "maximum": 41.99
        }
      ]
    },
    {
      "description": "Rpr s/n/ax/gen/trnk2.6-7.5cm",
      "code_information": [
        {
          "code": "12002",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 55.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 55.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 55.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 55.07,
              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Rpr s/n/ax/gen/trk7.6-12.5cm",
      "code_information": [
        {
          "code": "12004",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 68.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 68.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 68.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 68.47,
              "methodology": "fee schedule"
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      ]
    },
    {
      "description": "Rpr f/e/e/n/l/m 2.5 cm/<",
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        {
          "code": "12011",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 52.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 52.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 52.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 52.25,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 52.25,
          "maximum": 52.25
        }
      ]
    },
    {
      "description": "Rpr f/e/e/n/l/m 2.6-5.0 cm",
      "code_information": [
        {
          "code": "12013",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 54.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 54.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 54.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 54.34,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 54.34,
          "maximum": 54.34
        }
      ]
    },
    {
      "description": "Intmd rpr s/a/t/ext 2.6-7.5",
      "code_information": [
        {
          "code": "12032",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
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      "description": "Tis trnfr trunk 10 sq cm/<",
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        {
          "code": "14000",
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      ],
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        {
          "setting": "outpatient",
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      "description": "Tis trnfr s/a/l 10 sq cm/<",
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        {
          "code": "14020",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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      "description": "Grfg autol fat lipo 50 cc/<",
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        {
          "code": "15771",
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        {
          "setting": "outpatient",
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      "description": "Grfg autol fat lipo ea addl",
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        {
          "code": "15772",
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      ],
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        {
          "setting": "outpatient",
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      "description": "Removal sutr/stapl xreq anes",
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        {
          "code": "15853",
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        {
          "setting": "outpatient",
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      "description": "Dress/debrid p-thick burn s",
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        {
          "code": "16020",
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        {
          "setting": "outpatient",
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            {
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      "description": "Bx breast 1st lesion strtctc",
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          "code": "19081",
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      ],
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        {
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    {
      "description": "Bx breast 1st lesion us imag",
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          "code": "19083",
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      ],
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        {
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              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Removal of breast lesion",
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        {
          "code": "19120",
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        {
          "setting": "outpatient",
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    {
      "description": "Perq device breast 1st imag",
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        {
          "code": "19281",
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        {
          "setting": "outpatient",
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      "description": "Perq dev breast 1st us imag",
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          "code": "19285",
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        {
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            {
              "payer_name": "United Healthcare (UHC)",
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      "description": "Partial mastectomy",
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          "code": "19301",
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      ],
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        {
          "setting": "outpatient",
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    {
      "description": "P-mastectomy w/ln removal",
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        {
          "code": "19302",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
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    {
      "description": "Mast simple complete",
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      ],
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        {
          "setting": "outpatient",
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      "description": "Mast mod rad",
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        {
          "code": "19307",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
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          ],
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      ]
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    {
      "description": "Bone biopsy trocar/ndl deep",
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        {
          "code": "20225",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
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    {
      "description": "Drain/inj joint/bursa w/o us",
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        {
          "code": "20610",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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              "methodology": "fee schedule"
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ]
    },
    {
      "description": "Removal of implant deep",
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        {
          "code": "20680",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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              "methodology": "fee schedule"
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "estimated_amount": 405.34,
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      "description": "Cptr-asst dir ms px",
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        {
          "code": "20985",
          "type": "HCPCS"
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 135.75,
              "methodology": "fee schedule"
            },
            {
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              "standard_charge_percentage": 100,
              "estimated_amount": 135.75,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 135.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "estimated_amount": 135.75,
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    {
      "description": "Exc face tum deep 2 cm/>",
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        {
          "code": "21014",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 502.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 502.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 502.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 502.67,
              "methodology": "fee schedule"
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    {
      "description": "Exc neck les sc 3 cm/>",
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        {
          "code": "21552",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 429.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 429.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 429.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 429.19,
              "methodology": "fee schedule"
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          ],
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    {
      "description": "Exc back les sc 3 cm/>",
      "code_information": [
        {
          "code": "21931",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 450.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 450.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 450.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 450.97,
              "methodology": "fee schedule"
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          ],
          "minimum": 450.97,
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    {
      "description": "Osteot dsc ant 1vrt sgm lmbr",
      "code_information": [
        {
          "code": "22224",
          "type": "HCPCS"
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      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1512.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1512.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1512.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1512.54,
              "methodology": "fee schedule"
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          ],
          "minimum": 1512.54,
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    },
    {
      "description": "Perq vertebral augmentation",
      "code_information": [
        {
          "code": "22513",
          "type": "HCPCS"
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      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 479.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 479.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 479.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 479.95,
              "methodology": "fee schedule"
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          "minimum": 479.95,
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    },
    {
      "description": "Perq vertebral augmentation",
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        {
          "code": "22514",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 448.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 448.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 448.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 448.53,
              "methodology": "fee schedule"
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          ],
          "minimum": 448.53,
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      ]
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    {
      "description": "Perq vertebral augmentation",
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        {
          "code": "22515",
          "type": "HCPCS"
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      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 202.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 202.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 202.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 202.85,
              "methodology": "fee schedule"
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          ],
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    },
    {
      "description": "Arthrd ant toral/xoral c1-c2",
      "code_information": [
        {
          "code": "22548",
          "type": "HCPCS"
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      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1854.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1854.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1854.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 1854.5,
              "methodology": "fee schedule"
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          ],
          "minimum": 1854.5,
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      ]
    },
    {
      "description": "Arthrd ant ntrbd cervical ea",
      "code_information": [
        {
          "code": "22552",
          "type": "HCPCS"
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      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 367.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 367.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 367.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 367.35,
              "methodology": "fee schedule"
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          ],
          "minimum": 367.35,
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    {
      "description": "Repair rotator cuff chronic",
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        {
          "code": "23412",
          "type": "HCPCS"
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      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 822.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 822.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 822.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 822.53,
              "methodology": "fee schedule"
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    {
      "description": "Optx clavicular fx w/int fix",
      "code_information": [
        {
          "code": "23515",
          "type": "HCPCS"
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      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 699.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 699.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 699.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 699.06,
              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Cltx sho dslc w/mnpj wo anes",
      "code_information": [
        {
          "code": "23650",
          "type": "HCPCS"
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      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 301.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 301.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 301.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 301.54,
              "methodology": "fee schedule"
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          ],
          "minimum": 301.54,
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      ]
    },
    {
      "description": "Reconstruct elbow lat ligmnt",
      "code_information": [
        {
          "code": "24344",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 1066.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 1066.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 1066.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 1066.41,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 1066.41,
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        }
      ]
    },
    {
      "description": "Repair of humerus",
      "code_information": [
        {
          "code": "24430",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 1015.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 1015.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 1015.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 1015.81,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 1015.81,
          "maximum": 1015.81
        }
      ]
    },
    {
      "description": "Treat humerus fracture",
      "code_information": [
        {
          "code": "24516",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 827.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 827.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 827.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 827.85,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 827.85,
          "maximum": 827.85
        }
      ]
    },
    {
      "description": "Treat elbow dislocation",
      "code_information": [
        {
          "code": "24615",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 691.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 691.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 691.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 691.93,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 691.93,
          "maximum": 691.93
        }
      ]
    },
    {
      "description": "Treat ulnar fracture",
      "code_information": [
        {
          "code": "24685",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 637.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 637.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 637.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 637.53,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 637.53,
          "maximum": 637.53
        }
      ]
    },
    {
      "description": "Treat fx rad extra-articul",
      "code_information": [
        {
          "code": "25607",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 723.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 723.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 723.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 723.81,
              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Treat fx rad intra-articul",
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        {
          "code": "25608",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 805.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 805.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 805.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 805.8,
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          ],
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    {
      "description": "Treat fracture ulnar styloid",
      "code_information": [
        {
          "code": "25652",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 610.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 610.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 610.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 610.79,
              "methodology": "fee schedule"
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          ],
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      ]
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    {
      "description": "Treat thumb fracture",
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        {
          "code": "26645",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 393.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 393.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 393.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 393.65,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 393.65,
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      ]
    },
    {
      "description": "Total hip arthroplasty",
      "code_information": [
        {
          "code": "27130",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 1225.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 1225.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1225.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 1225.56,
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          ],
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    },
    {
      "description": "Revision of unstable kneecap",
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        {
          "code": "27422",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 720.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 720.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 720.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 720.43,
              "methodology": "fee schedule"
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          ],
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    },
    {
      "description": "Lat retinacular release open",
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        {
          "code": "27425",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 446.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 446.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 446.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 446.48,
              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Reconstruction knee",
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        {
          "code": "27427",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 686.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 686.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 686.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 686.37,
              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Revision of knee joint",
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        {
          "code": "27446",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1098.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1098.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1098.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 1098.63,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 1098.63,
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      ]
    },
    {
      "description": "Total knee arthroplasty",
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        {
          "code": "27447",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1224.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1224.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1224.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 1224.03,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 1224.03,
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      ]
    },
    {
      "description": "Treat kneecap fracture",
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        {
          "code": "27524",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 729.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 729.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 729.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 729.15,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 729.15,
          "maximum": 729.15
        }
      ]
    },
    {
      "description": "Fixation of knee joint",
      "code_information": [
        {
          "code": "27570",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 151.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 151.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 151.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 151.08,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 151.08,
          "maximum": 151.08
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      ]
    },
    {
      "description": "Reconstruction ankle joint",
      "code_information": [
        {
          "code": "27703",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 1067.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 1067.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1067.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 1067.7,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 1067.7,
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      ]
    },
    {
      "description": "Realignment of lower leg",
      "code_information": [
        {
          "code": "27712",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 1059.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1059.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1059.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 1059.25,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 1059.25,
          "maximum": 1059.25
        }
      ]
    },
    {
      "description": "Part removal of metatarsal",
      "code_information": [
        {
          "code": "28110",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 288.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 288.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 288.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 288.44,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 288.44,
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      ]
    },
    {
      "description": "Repair of hammertoe",
      "code_information": [
        {
          "code": "28285",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 379.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 379.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 379.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 379.21,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 379.21,
          "maximum": 379.21
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      ]
    },
    {
      "description": "Treat/graft heel fracture",
      "code_information": [
        {
          "code": "28420",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 1244.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1244.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1244.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 1244.96,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 1244.96,
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      ]
    },
    {
      "description": "Apply long arm splint",
      "code_information": [
        {
          "code": "29105",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 39.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.08,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39.08,
          "maximum": 39.08
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      ]
    },
    {
      "description": "Apply forearm splint",
      "code_information": [
        {
          "code": "29125",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Commercial",
              "standard_charge_percentage": 85,
              "estimated_amount": 152.15,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 161.1,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 125.3,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 152.15,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 152.15,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 57.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 179,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 179,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39.11,
          "maximum": 179
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      ]
    },
    {
      "description": "Application long leg splint",
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        {
          "code": "29505",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 50.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 50.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 50.98,
              "methodology": "fee schedule"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 50.98,
              "methodology": "fee schedule"
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          ],
          "minimum": 50.98,
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      ]
    },
    {
      "description": "Application lower leg splint",
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        {
          "code": "29515",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 48.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 48.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 48.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 48.15,
              "methodology": "fee schedule"
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          ],
          "minimum": 48.15,
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      ]
    },
    {
      "description": "Sho arthrs dx +- synovial bx",
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        {
          "code": "29805",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 458.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 458.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 458.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 458.74,
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          ],
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      ]
    },
    {
      "description": "Sho arthrs srg lmtd dbrdmt",
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        {
          "code": "29822",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 527.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 527.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 527.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 527.16,
              "methodology": "fee schedule"
            }
          ],
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        }
      ]
    },
    {
      "description": "Sho arthrs srg decompression",
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        {
          "code": "29826",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 161.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 161.6,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 161.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 161.6,
              "methodology": "fee schedule"
            }
          ],
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        }
      ]
    },
    {
      "description": "Sho arthrs srg rt8tr cuf rpr",
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        {
          "code": "29827",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 1024.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1024.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1024.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 1024.71,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Sho arthrs srg bicp tenodsis",
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        {
          "code": "29828",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 880.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 880.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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        }
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    },
    {
      "description": "Knee arthroscopy/surgery",
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        {
          "code": "29880",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 545.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 545.89,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Knee arthroscopy/surgery",
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        {
          "code": "29881",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 526.51,
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            },
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              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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    },
    {
      "description": "Excise inferior turbinate",
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        {
          "code": "30130",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 400.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "payer_name": "Coventry Health Care",
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Resect inferior turbinate",
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        {
          "code": "30140",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
          "minimum": 169.99,
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      ]
    },
    {
      "description": "Repair of nasal septum",
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        {
          "code": "30520",
          "type": "HCPCS"
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      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 645.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 645.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            }
          ],
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        }
      ]
    },
    {
      "description": "Ablate inf turbinate superf",
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        {
          "code": "30801",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 144.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Nsl/sins ndsc surg bx polypc",
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        {
          "code": "31237",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 152.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 152.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 152.94,
              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Nsl/sins ndsc w/prtl ethmdct",
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        {
          "code": "31254",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 230.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 230.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 230.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Exploration maxillary sinus",
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        {
          "code": "31256",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 171.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 171.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 171.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 171.59,
              "methodology": "fee schedule"
            }
          ],
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        }
      ]
    },
    {
      "description": "Nsl/sins ndsc tot w/sphendt",
      "code_information": [
        {
          "code": "31257",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 420.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 420.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 420.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 420.82,
              "methodology": "fee schedule"
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          ],
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          "maximum": 420.82
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      ]
    },
    {
      "description": "Nsl/sins ndsc sphn tiss rmvl",
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        {
          "code": "31259",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 445.29,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 445.29,
              "methodology": "fee schedule"
            },
            {
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              "estimated_amount": 445.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 445.29,
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      ]
    },
    {
      "description": "Endoscopy maxillary sinus",
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        {
          "code": "31267",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 250.85,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 250.85,
              "methodology": "fee schedule"
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 250.85,
              "methodology": "fee schedule"
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Nsl/sins ndsc frnt tiss rmvl",
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        {
          "code": "31276",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "estimated_amount": 357.24,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
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              "estimated_amount": 357.24,
              "methodology": "fee schedule"
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              "estimated_amount": 357.24,
              "methodology": "fee schedule"
            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 357.24,
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    },
    {
      "description": "Nasal/sinus endoscopy surg",
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        {
          "code": "31288",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 221.68,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 221.68,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
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              "estimated_amount": 221.68,
              "methodology": "fee schedule"
            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 221.68,
              "methodology": "fee schedule"
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    {
      "description": "Insert emergency airway",
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        {
          "code": "31500",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 132.86,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 132.86,
              "methodology": "fee schedule"
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              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 132.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "estimated_amount": 132.86,
              "methodology": "fee schedule"
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      ]
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    {
      "description": "Core ndl bx lng/med perq",
      "code_information": [
        {
          "code": "32408",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 142.06,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
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              "estimated_amount": 142.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
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              "estimated_amount": 142.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "estimated_amount": 142.06,
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    {
      "description": "Aspirate pleura w/ imaging",
      "code_information": [
        {
          "code": "32555",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 102.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 102.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 102.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 102.06,
              "methodology": "fee schedule"
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          ],
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          "maximum": 102.06
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      ]
    },
    {
      "description": "Insert heart pm ventricular",
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        {
          "code": "33207",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 443.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 443.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 443.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 443.41,
              "methodology": "fee schedule"
            }
          ],
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    {
      "description": "Remove&replace pm gen singl",
      "code_information": [
        {
          "code": "33227",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 315.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 315.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 315.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 315.12,
              "methodology": "fee schedule"
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          ],
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    },
    {
      "description": "Remv&replc pm gen dual lead",
      "code_information": [
        {
          "code": "33228",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 329.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 329.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 329.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 329.65,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 329.65,
          "maximum": 329.65
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      ]
    },
    {
      "description": "Place catheter in vein",
      "code_information": [
        {
          "code": "36012",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 161.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 161.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 161.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 161.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 161.2,
          "maximum": 161.2
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      ]
    },
    {
      "description": "Place catheter in aorta",
      "code_information": [
        {
          "code": "36200",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.37,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 127.37,
          "maximum": 127.37
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      ]
    },
    {
      "description": "Place cath subclavian art",
      "code_information": [
        {
          "code": "36225",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 301.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 301.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 301.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 301.93,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 301.93,
          "maximum": 301.93
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      ]
    },
    {
      "description": "Ins cath abd/l-ext art 3rd",
      "code_information": [
        {
          "code": "36247",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 273.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 273.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 273.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 273.38,
              "methodology": "fee schedule"
            }
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          "minimum": 273.38,
          "maximum": 273.38
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      ]
    },
    {
      "description": "Ins cath abd/l-ext art addl",
      "code_information": [
        {
          "code": "36248",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 44.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 44.83,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 44.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 44.83,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Routine venipuncture",
      "code_information": [
        {
          "code": "36415",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 9.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 9.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 9.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 9.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 9.09,
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      ]
    },
    {
      "description": "Transfusion bld/bld compnt",
      "code_information": [
        {
          "code": "36430",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 41.47,
          "maximum": 41.47
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      ]
    },
    {
      "description": "Intrauterine transfusion ftl",
      "code_information": [
        {
          "code": "36460",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 321.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 321.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 321.53,
              "methodology": "fee schedule"
            }
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          "minimum": 321.53,
          "maximum": 321.53
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      ]
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    {
      "description": "Apheresis plasma",
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        {
          "code": "36514",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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      "description": "Insert non-tunnel cv cath",
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        {
          "code": "36556",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
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      "description": "Insert tunneled cv cath",
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          "code": "36558",
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        {
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            {
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      "description": "Insert tunneled cv cath",
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        {
          "code": "36561",
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        {
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            {
              "payer_name": "United Healthcare (UHC)",
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      "description": "Insj picc 5 yr+ w/o imaging",
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        {
          "code": "36569",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Insj picc rs&i 5 yr+",
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        {
          "code": "36573",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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      "description": "Removal tunneled cv cath",
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        {
          "code": "36589",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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      "description": "Removal tunneled cv cath",
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          "code": "36590",
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      ],
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        {
          "setting": "outpatient",
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      "description": "Reposition venous catheter",
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          "code": "36597",
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      ],
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        {
          "setting": "outpatient",
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      "description": "Withdrawal of arterial blood",
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        {
          "code": "36600",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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    {
      "description": "Av fuse uppr arm basilic",
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        {
          "code": "36819",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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            },
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            },
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    {
      "description": "Av fusion direct any site",
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        {
          "code": "36821",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    },
    {
      "description": "Artery-vein nonautograft",
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        {
          "code": "36830",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ]
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    {
      "description": "Av fistula revision open",
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        {
          "code": "36832",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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            },
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ]
    },
    {
      "description": "Intro cath dialysis circuit",
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        {
          "code": "36901",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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          ],
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      ]
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    {
      "description": "Intro cath dialysis circuit",
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        {
          "code": "36902",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
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      "description": "Intro cath dialysis circuit",
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        {
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          "type": "HCPCS"
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      ],
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        {
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            },
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Thrmbc/nfs dialysis circuit",
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        {
          "code": "36905",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
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              "estimated_amount": 408.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
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      ]
    },
    {
      "description": "Thrmbc/nfs dialysis circuit",
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        {
          "code": "36906",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Balo angiop ctr dialysis seg",
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        {
          "code": "36907",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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      ]
    },
    {
      "description": "Dialysis circuit embolj",
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        {
          "code": "36909",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
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    },
    {
      "description": "Rem endovas vena cava filter",
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        {
          "code": "37193",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Thrombolytic art therapy",
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        {
          "code": "37211",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
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      "description": "Fem/popl revas w/tla",
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        {
          "code": "37224",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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      "description": "Fem/popl revas w/ather",
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        {
          "code": "37225",
          "type": "HCPCS"
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      ],
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        {
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            {
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      "description": "Tib/per revasc w/tla",
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        {
          "code": "37228",
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      ],
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        {
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            {
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Tib/per revasc w/ather",
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          "code": "37229",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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      "description": "Tib/per revasc add-on",
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        {
          "code": "37232",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 181.3,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Tibper revasc w/ather add-on",
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        {
          "code": "37233",
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      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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            },
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    {
      "description": "Open/perq place stent same",
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        {
          "code": "37238",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
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              "estimated_amount": 280.51,
              "methodology": "fee schedule"
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    {
      "description": "Open/perq place stent ea add",
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        {
          "code": "37239",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Vasc embolize/occlude organ",
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        {
          "code": "37243",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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      ]
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    {
      "description": "Trluml balo angiop 1st art",
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        {
          "code": "37246",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Intrvasc us noncoronary 1st",
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        {
          "code": "37252",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
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            }
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      ]
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    {
      "description": "Intrvasc us noncoronary addl",
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        {
          "code": "37253",
          "type": "HCPCS"
        }
      ],
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        {
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            {
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    {
      "description": "Phleb veins - extrem 20+",
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        {
          "code": "37766",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
            },
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            },
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            },
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      ]
    },
    {
      "description": "Dx bone marrow bx & aspir",
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        {
          "code": "38222",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
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      ]
    },
    {
      "description": "Biopsy/removal lymph nodes",
      "code_information": [
        {
          "code": "38500",
          "type": "HCPCS"
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      ],
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        {
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      ]
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    {
      "description": "Needle biopsy lymph nodes",
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        {
          "code": "38505",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
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    },
    {
      "description": "Biopsy/removal lymph nodes",
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        {
          "code": "38525",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Open bx/exc inguinofem nodes",
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        {
          "code": "38531",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Laparoscopy lymph node biop",
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        {
          "code": "38570",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Laparoscopy lymphadenectomy",
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        {
          "code": "38571",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
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    {
      "description": "Io map of sent lymph node",
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        {
          "code": "38900",
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      ],
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        {
          "setting": "outpatient",
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      "description": "Remove tonsils and adenoids",
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        {
          "code": "42821",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
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            },
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              "methodology": "fee schedule"
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              "estimated_amount": 294.53,
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            },
            {
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          ],
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    {
      "description": "Removal of tonsils",
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        {
          "code": "42826",
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      ],
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        {
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 248.73,
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    {
      "description": "Egd diagnostic brush wash",
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        {
          "code": "43235",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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    {
      "description": "Egd biopsy single/multiple",
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        {
          "code": "43239",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
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              "estimated_amount": 130.17,
              "methodology": "fee schedule"
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    {
      "description": "Egd varices ligation",
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        {
          "code": "43244",
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      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
            },
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            },
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Egd place gastrostomy tube",
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        {
          "code": "43246",
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      ],
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        {
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            {
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    {
      "description": "Laparoscopy fundoplasty",
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        {
          "code": "43280",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
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    {
      "description": "Reposition gastrostomy tube",
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        {
          "code": "43761",
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      ],
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        {
          "setting": "outpatient",
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            {
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    {
      "description": "Rplc gtube no revj trc",
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        {
          "code": "43762",
          "type": "HCPCS"
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      ],
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        {
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            {
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              "methodology": "fee schedule"
            },
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      "description": "Laparoscopy appendectomy",
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        {
          "code": "44970",
          "type": "HCPCS"
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        {
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      "description": "Proctosigmoidoscopy dx",
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        {
          "code": "45300",
          "type": "HCPCS"
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        {
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    {
      "description": "Diagnostic colonoscopy",
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        {
          "code": "45378",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            },
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            },
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      "description": "Colonoscopy and biopsy",
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        {
          "code": "45380",
          "type": "HCPCS"
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      ],
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        {
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      "description": "Colonoscopy submucous njx",
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        {
          "code": "45381",
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      ],
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        {
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      "description": "Colonoscopy w/lesion removal",
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        {
          "code": "45385",
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      ],
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        {
          "setting": "outpatient",
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              "methodology": "fee schedule"
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      "description": "Colonoscopy w/ablation",
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        {
          "code": "45388",
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        {
          "setting": "outpatient",
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      "description": "Remove int/ext hem 1 group",
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        {
          "code": "46255",
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      ],
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        {
          "setting": "outpatient",
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      "description": "Remove in/ex hem groups 2+",
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        {
          "code": "46260",
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        {
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      "description": "Diagnostic anoscopy & biopsy",
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        {
          "code": "46607",
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        {
          "setting": "outpatient",
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    {
      "description": "Destruction anal lesion(s)",
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        {
          "code": "46924",
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        {
          "setting": "outpatient",
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      "description": "Needle biopsy of liver",
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        {
          "code": "47000",
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        {
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      "description": "Laparoscopic cholecystectomy",
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        {
          "code": "47562",
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        {
          "setting": "outpatient",
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      "description": "Laparo cholecystectomy/graph",
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        {
          "code": "47563",
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        {
          "setting": "outpatient",
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      "description": "Abd paracentesis w/imaging",
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        {
          "code": "49083",
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        {
          "setting": "outpatient",
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            {
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      "description": "Laparoscopy aspiration",
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        {
          "code": "49322",
          "type": "HCPCS"
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        {
          "setting": "outpatient",
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            {
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    {
      "description": "Lap insert tunnel ip cath",
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        {
          "code": "49324",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Remove tunneled ip cath",
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        {
          "code": "49422",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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              "methodology": "fee schedule"
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      "description": "Prp i/hern init reduc >5 yr",
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        {
          "code": "49505",
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        {
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        {
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      "description": "Rerepair ing hernia reduce",
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        {
          "code": "49520",
          "type": "HCPCS"
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        {
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            },
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              "methodology": "fee schedule"
            },
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    {
      "description": "Rpr aa hrn 1st < 3 cm rdc",
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        {
          "code": "49591",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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      "description": "Rpr aa hrn 1st < 3 ncr/strn",
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        {
          "code": "49592",
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      ],
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        {
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        {
          "code": "49594",
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        {
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      "description": "Lap ing hernia repair init",
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        {
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        {
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    {
      "description": "Lap ing hernia repair recur",
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        {
          "code": "49651",
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        {
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            {
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          "code": "50435",
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        {
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        {
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        {
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      "description": "Drain bl w/cath insertion",
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        {
          "code": "51102",
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        {
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      "description": "Insert temp bladder cath",
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        {
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      "description": "Us urine capacity measure",
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        {
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        {
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      "description": "Remove bladder stone",
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        {
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        {
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    {
      "description": "Cysto/uretero w/lithotripsy",
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        {
          "code": "52356",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
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    {
      "description": "Prostatectomy (turp)",
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        {
          "code": "52601",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
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    {
      "description": "Insert uro/ves nck sphincter",
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        {
          "code": "53445",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
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    {
      "description": "Circum 28 days or older",
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        {
          "code": "54161",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 189.73,
              "methodology": "fee schedule"
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    {
      "description": "Removal of hydrocele",
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        {
          "code": "55040",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
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            {
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    {
      "description": "Biopsy of prostate",
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        {
          "code": "55700",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
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              "estimated_amount": 122.41,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 122.41,
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            {
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    {
      "description": "Abltj mal prst8 tiss hifu",
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        {
          "code": "55880",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
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            {
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              "estimated_amount": 933.24,
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            },
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    },
    {
      "description": "Cmbn ant pst colprhy",
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        {
          "code": "57260",
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        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 740.22,
              "methodology": "fee schedule"
            },
            {
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            },
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              "estimated_amount": 740.22,
              "methodology": "fee schedule"
            },
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      "description": "Repair bladder defect",
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        {
          "code": "57288",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 710.07,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 710.07,
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            },
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              "methodology": "fee schedule"
            },
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          ],
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    {
      "description": "Conz of cervix w/scope leep",
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        {
          "code": "57461",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 173.01,
              "methodology": "fee schedule"
            },
            {
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              "methodology": "fee schedule"
            },
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ]
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    {
      "description": "Conization of cervix",
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        {
          "code": "57522",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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            },
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              "estimated_amount": 244.89,
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            {
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      ]
    },
    {
      "description": "Dilation and curettage",
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        {
          "code": "58120",
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        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 222.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 222.98,
              "methodology": "fee schedule"
            },
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              "standard_charge_percentage": 100,
              "estimated_amount": 222.98,
              "methodology": "fee schedule"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Remove intrauterine device",
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        {
          "code": "58301",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 62.27,
              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
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              "estimated_amount": 62.27,
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            },
            {
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              "estimated_amount": 62.27,
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          ],
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      ]
    },
    {
      "description": "Laparo-asst vag hysterectomy",
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        {
          "code": "58550",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
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            },
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              "estimated_amount": 839.31,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            }
          ],
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      ]
    },
    {
      "description": "Laparo-vag hyst incl t/o",
      "code_information": [
        {
          "code": "58552",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "estimated_amount": 932.85,
              "methodology": "fee schedule"
            },
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      ]
    },
    {
      "description": "Laparo-vag hyst w/t/o compl",
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        {
          "code": "58554",
          "type": "HCPCS"
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      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
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      ]
    },
    {
      "description": "Hysteroscopy biopsy",
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        {
          "code": "58558",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 218.49,
              "methodology": "fee schedule"
            },
            {
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              "estimated_amount": 218.49,
              "methodology": "fee schedule"
            },
            {
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              "standard_charge_percentage": 100,
              "estimated_amount": 218.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Hysteroscopy remove myoma",
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        {
          "code": "58561",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 336.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 336.74,
              "methodology": "fee schedule"
            },
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              "standard_charge_percentage": 100,
              "estimated_amount": 336.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Hysteroscopy ablation",
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        {
          "code": "58563",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "estimated_amount": 231.82,
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      "description": "Tlh uterus 250 g or less",
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        {
          "code": "58570",
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      ],
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      "description": "Laparoscopy remove adnexa",
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          "code": "58661",
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      "description": "Laparoscopy excise lesions",
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        {
          "code": "58662",
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        {
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      "description": "Fetal cord puncture prenatal",
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        {
          "code": "59012",
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      "description": "Care of miscarriage",
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        {
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      "description": "Scan proc cranial extra",
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          "code": "61782",
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      ],
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        {
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        {
          "code": "62328",
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      ],
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      "description": "Njx aa&/strd other pn/branch",
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        {
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      "description": "Revise ulnar nerve at elbow",
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        {
          "code": "64718",
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      ],
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        {
          "setting": "outpatient",
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      "description": "Carpal tunnel surgery",
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          "code": "64721",
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        {
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      "description": "Removal of eye lesion",
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          "code": "65426",
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        {
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      "description": "Corneal transplant",
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        {
          "setting": "outpatient",
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    {
      "description": "Corneal transplant",
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        {
          "code": "65755",
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      ],
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        {
          "setting": "outpatient",
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Corneal trnspl endothelial",
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        {
          "code": "65756",
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        }
      ],
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        {
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              "estimated_amount": 1122.77,
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          ],
          "minimum": 1122.77,
          "maximum": 1122.77
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      ]
    },
    {
      "description": "Relieve inner eye pressure",
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        {
          "code": "65820",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 780.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
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              "estimated_amount": 780.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 780.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Glaucoma surgery",
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        {
          "code": "66170",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 1040.53,
              "methodology": "fee schedule"
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              "estimated_amount": 1040.53,
              "methodology": "fee schedule"
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              "estimated_amount": 1040.53,
              "methodology": "fee schedule"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Aqueous shunt eye w/graft",
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        {
          "code": "66180",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1081.9,
              "methodology": "fee schedule"
            },
            {
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              "estimated_amount": 1081.9,
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Follow-up surgery of eye",
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        {
          "code": "66250",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 529.64,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 529.64,
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              "estimated_amount": 529.64,
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Incision of iris",
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        {
          "code": "66500",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 373.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 373.74,
              "methodology": "fee schedule"
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            {
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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    },
    {
      "description": "Removal of iris",
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        {
          "code": "66625",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 408.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 408.87,
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            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 408.87,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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    {
      "description": "Removal of iris",
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        {
          "code": "66630",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
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            },
            {
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              "methodology": "fee schedule"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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          ],
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      ]
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    {
      "description": "After cataract laser surgery",
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        {
          "code": "66821",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 296.77,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 296.77,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 296.77,
              "methodology": "fee schedule"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
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    {
      "description": "Xcapsl ctrc rmvl cplx wo ecp",
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        {
          "code": "66982",
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      ],
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        {
          "setting": "outpatient",
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            {
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            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 707.86,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 707.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ]
    },
    {
      "description": "Xcapsl ctrc rmvl w/o ecp",
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        {
          "code": "66984",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
            {
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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      "description": "Xcapsl ctrc rmvl insj 1+",
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        {
          "code": "66991",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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    {
      "description": "Injection eye drug",
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        {
          "code": "67028",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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            },
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              "methodology": "fee schedule"
            },
            {
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    {
      "description": "Dstrj extensive retinopathy",
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        {
          "code": "67227",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
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              "methodology": "fee schedule"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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    },
    {
      "description": "Reinforce/graft eye wall",
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        {
          "code": "67255",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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      ]
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    {
      "description": "Remove eyelid lesion",
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        {
          "code": "67800",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
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    {
      "description": "Remove impacted ear wax uni",
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        {
          "code": "69209",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 15.12,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 15.12,
              "methodology": "fee schedule"
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              "estimated_amount": 15.12,
              "methodology": "fee schedule"
            },
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    {
      "description": "X-ray exam of nasal bones",
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        {
          "code": "70160",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
            {
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            }
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    {
      "description": "X-ray exam of neck",
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        {
          "code": "70360",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 30.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 30.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Ct head/brain w/o dye",
      "code_information": [
        {
          "code": "70450",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 104.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.7,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 104.7,
          "maximum": 104.7
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      ]
    },
    {
      "description": "Ct orbit/ear/fossa w/o dye",
      "code_information": [
        {
          "code": "70480",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 155.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 155.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 155.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "estimated_amount": 155.88,
              "methodology": "fee schedule"
            }
          ],
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          "maximum": 155.88
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      ]
    },
    {
      "description": "Ct maxillofacial w/o dye",
      "code_information": [
        {
          "code": "70486",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 125.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 125.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 125.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 125.73,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 125.73,
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      ]
    },
    {
      "description": "Ct maxillofacial w/dye",
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        {
          "code": "70487",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 149.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 149.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 149.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 149.17,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 149.17,
          "maximum": 149.17
        }
      ]
    },
    {
      "description": "Ct soft tissue neck w/o dye",
      "code_information": [
        {
          "code": "70490",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 147.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 147.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 147.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 147.23,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 147.23,
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        }
      ]
    },
    {
      "description": "Ct soft tissue neck w/dye",
      "code_information": [
        {
          "code": "70491",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 180.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 180.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 180.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 180.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 180.47,
          "maximum": 180.47
        }
      ]
    },
    {
      "description": "Ct angiography head",
      "code_information": [
        {
          "code": "70496",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 271.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 271.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 271.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 271.43,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 271.43,
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        }
      ]
    },
    {
      "description": "Ct angiography neck",
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        {
          "code": "70498",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 271.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 271.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 271.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 271.11,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 271.11,
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        }
      ]
    },
    {
      "description": "Mri brain stem w/o dye",
      "code_information": [
        {
          "code": "70551",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 192.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 192.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 192.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 192.67,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 192.67,
          "maximum": 192.67
        }
      ]
    },
    {
      "description": "Mri brain stem w/o & w/dye",
      "code_information": [
        {
          "code": "70553",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 312.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 312.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 312.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 312.73,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "X-ray exam chest 1 view",
      "code_information": [
        {
          "code": "71045",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 25.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Commercial",
              "standard_charge_percentage": 85,
              "estimated_amount": 88.54,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice of the Midwest",
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              "standard_charge_percentage": 90,
              "estimated_amount": 93.74,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "standard_charge_percentage": 70,
              "estimated_amount": 72.91,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 88.54,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 25.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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              "estimated_amount": 25.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 25.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
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              "estimated_amount": 88.54,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 25.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
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              "standard_charge_percentage": 90,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 25.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 17.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 104.16,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17.38,
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        }
      ]
    },
    {
      "description": "X-ray exam chest 2 views",
      "code_information": [
        {
          "code": "71046",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Commercial",
              "standard_charge_percentage": 85,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice of the Midwest",
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              "standard_charge_percentage": 90,
              "estimated_amount": 122.72,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "estimated_amount": 95.45,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "standard_charge_percentage": 85,
              "estimated_amount": 115.91,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 32.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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              "estimated_amount": 32.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 32.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
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              "estimated_amount": 115.91,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
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              "standard_charge_percentage": 90,
              "estimated_amount": 122.72,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 32.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 136.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 136.36,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27.07,
          "maximum": 136.36
        }
      ]
    },
    {
      "description": "X-ray exam ribs uni 2 views",
      "code_information": [
        {
          "code": "71100",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.41,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 35.41,
          "maximum": 35.41
        }
      ]
    },
    {
      "description": "X-ray exam unilat ribs/chest",
      "code_information": [
        {
          "code": "71101",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 40.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 40.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 40.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 40.59,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 40.59,
          "maximum": 40.59
        }
      ]
    },
    {
      "description": "X-ray exam ribs bil 3 views",
      "code_information": [
        {
          "code": "71110",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 42.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 42.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 42.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 42.21,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 42.21,
          "maximum": 42.21
        }
      ]
    },
    {
      "description": "X-ray exam ribs/chest4/> vws",
      "code_information": [
        {
          "code": "71111",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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              "methodology": "fee schedule"
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ]
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    {
      "description": "Ct thorax dx c-",
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        {
          "code": "71250",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 130.5,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Ct thorax dx c+",
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        {
          "code": "71260",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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      "description": "Ct angiography chest",
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        {
          "code": "71275",
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        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 276.76,
              "methodology": "fee schedule"
            },
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "X-ray exam of spine 1 view",
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        {
          "code": "72020",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "X-ray exam neck spine 2-3 vw",
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        {
          "code": "72040",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            {
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ]
    },
    {
      "description": "X-ray exam neck spine 4/5vws",
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        {
          "code": "72050",
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        }
      ],
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        {
          "setting": "outpatient",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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            },
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "X-ray exam thorac spine 2vws",
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        {
          "code": "72070",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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            },
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ]
    },
    {
      "description": "X-ray exam thorac spine 3vws",
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        {
          "code": "72072",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 38,
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            },
            {
              "payer_name": "Coventry Health Care",
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            },
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            }
          ],
          "minimum": 38,
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        }
      ]
    },
    {
      "description": "X-ray exam l-s spine 2/3 vws",
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        {
          "code": "72100",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            }
          ],
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      ]
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    {
      "description": "X-ray exam l-2 spine 4/>vws",
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        {
          "code": "72110",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Ct neck spine w/o dye",
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        {
          "code": "72125",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 127.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 127.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 127.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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        }
      ]
    },
    {
      "description": "Ct chest spine w/o dye",
      "code_information": [
        {
          "code": "72128",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 127.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 127.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 127.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.35,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 127.35,
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        }
      ]
    },
    {
      "description": "Ct lumbar spine w/o dye",
      "code_information": [
        {
          "code": "72131",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 127.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 127.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 127.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.02,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 127.02,
          "maximum": 127.02
        }
      ]
    },
    {
      "description": "Mri neck spine w/o dye",
      "code_information": [
        {
          "code": "72141",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 186.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 186.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 186.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 186.85,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 186.85,
          "maximum": 186.85
        }
      ]
    },
    {
      "description": "Mri chest spine w/o dye",
      "code_information": [
        {
          "code": "72146",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 187.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 187.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 187.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 187.17,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Mri lumbar spine w/o dye",
      "code_information": [
        {
          "code": "72148",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 187.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 187.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 187.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 187.5,
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      ]
    },
    {
      "description": "Mri neck spine w/o & w/dye",
      "code_information": [
        {
          "code": "72156",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 313.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 313.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 313.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 313.7,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 313.7,
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      ]
    },
    {
      "description": "X-ray exam of pelvis",
      "code_information": [
        {
          "code": "72170",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 108.36,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 84.28,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 102.34,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 102.34,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 108.36,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 19.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 120.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 120.4,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19.05,
          "maximum": 120.4
        }
      ]
    },
    {
      "description": "Ct angiograph pelv w/o&w/dye",
      "code_information": [
        {
          "code": "72191",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 298.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 298.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 298.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 298.75,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 298.75,
          "maximum": 298.75
        }
      ]
    },
    {
      "description": "Ct pelvis w/o dye",
      "code_information": [
        {
          "code": "72192",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 130.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 130.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 130.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 130.5,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 130.5,
          "maximum": 130.5
        }
      ]
    },
    {
      "description": "Ct pelvis w/dye",
      "code_information": [
        {
          "code": "72193",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 222.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 222.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 222.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 222.6,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 222.6,
          "maximum": 222.6
        }
      ]
    },
    {
      "description": "Mri pelvis w/o dye",
      "code_information": [
        {
          "code": "72195",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 223.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 223.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 223.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 223.72,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 223.72,
          "maximum": 223.72
        }
      ]
    },
    {
      "description": "Mri pelvis w/o & w/dye",
      "code_information": [
        {
          "code": "72197",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 329.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 329.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 329.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 329.96,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 329.96,
          "maximum": 329.96
        }
      ]
    },
    {
      "description": "X-ray exam sacrum tailbone",
      "code_information": [
        {
          "code": "72220",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.53,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31.53,
          "maximum": 31.53
        }
      ]
    },
    {
      "description": "X-ray exam of collar bone",
      "code_information": [
        {
          "code": "73000",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.53,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31.53,
          "maximum": 31.53
        }
      ]
    },
    {
      "description": "X-ray exam of shoulder",
      "code_information": [
        {
          "code": "73020",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 20.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 20.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20.86,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20.86,
          "maximum": 20.86
        }
      ]
    },
    {
      "description": "X-ray exam of shoulder",
      "code_information": [
        {
          "code": "73030",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 33.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 123.08,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 95.73,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 116.25,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 33.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 33.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 33.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 116.25,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 123.08,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 21.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 273.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 273.52,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21.05,
          "maximum": 273.52
        }
      ]
    },
    {
      "description": "X-ray exam of humerus",
      "code_information": [
        {
          "code": "73060",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.88,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30.88,
          "maximum": 30.88
        }
      ]
    },
    {
      "description": "X-ray exam of elbow",
      "code_information": [
        {
          "code": "73070",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.3,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28.3,
          "maximum": 28.3
        }
      ]
    },
    {
      "description": "X-ray exam of elbow",
      "code_information": [
        {
          "code": "73080",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.53,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31.53,
          "maximum": 31.53
        }
      ]
    },
    {
      "description": "X-ray exam of forearm",
      "code_information": [
        {
          "code": "73090",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.3,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28.3,
          "maximum": 28.3
        }
      ]
    },
    {
      "description": "X-ray exam of wrist",
      "code_information": [
        {
          "code": "73100",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 123.08,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 95.73,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 116.25,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 116.25,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 123.08,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 19.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 273.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 273.52,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19.38,
          "maximum": 273.52
        }
      ]
    },
    {
      "description": "X-ray exam of wrist",
      "code_information": [
        {
          "code": "73110",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.94,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39.94,
          "maximum": 39.94
        }
      ]
    },
    {
      "description": "X-ray exam of hand",
      "code_information": [
        {
          "code": "73120",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.24,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30.24,
          "maximum": 30.24
        }
      ]
    },
    {
      "description": "X-ray exam of hand",
      "code_information": [
        {
          "code": "73130",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 36.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 36.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36.06,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 36.06,
          "maximum": 36.06
        }
      ]
    },
    {
      "description": "X-ray exam of finger(s)",
      "code_information": [
        {
          "code": "73140",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.03,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 37.03,
          "maximum": 37.03
        }
      ]
    },
    {
      "description": "Ct upper extremity w/o dye",
      "code_information": [
        {
          "code": "73200",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 157.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 157.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 157.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 157.67,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 157.67,
          "maximum": 157.67
        }
      ]
    },
    {
      "description": "Mri joint upr extrem w/o dye",
      "code_information": [
        {
          "code": "73221",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 199.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 199.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 199.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 199.79,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 199.79,
          "maximum": 199.79
        }
      ]
    },
    {
      "description": "X-ray exam hip uni 1 view",
      "code_information": [
        {
          "code": "73501",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.18,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32.18,
          "maximum": 32.18
        }
      ]
    },
    {
      "description": "X-ray exam hip uni 2-3 views",
      "code_information": [
        {
          "code": "73502",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 46.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 46.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 46.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 46.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 46.09,
          "maximum": 46.09
        }
      ]
    },
    {
      "description": "X-ray exam hip uni 4/> views",
      "code_information": [
        {
          "code": "73503",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 58.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 58.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 58.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 58.62,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 58.62,
          "maximum": 58.62
        }
      ]
    },
    {
      "description": "X-ray exam hips bi 2 views",
      "code_information": [
        {
          "code": "73521",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.94,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39.94,
          "maximum": 39.94
        }
      ]
    },
    {
      "description": "X-ray exam hips bi 3-4 views",
      "code_information": [
        {
          "code": "73522",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 52.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 52.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 52.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 52.23,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 52.23,
          "maximum": 52.23
        }
      ]
    },
    {
      "description": "X-ray exam of femur 1",
      "code_information": [
        {
          "code": "73551",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.62,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 28.62,
          "maximum": 28.62
        }
      ]
    },
    {
      "description": "X-ray exam of femur 2/>",
      "code_information": [
        {
          "code": "73552",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 34.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 34.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 34.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 34.44,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34.44,
          "maximum": 34.44
        }
      ]
    },
    {
      "description": "X-ray exam of knee 1 or 2",
      "code_information": [
        {
          "code": "73560",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 84.24,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 65.52,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 79.56,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 79.56,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 84.24,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 20.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 187.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 187.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 20.05,
          "maximum": 187.2
        }
      ]
    },
    {
      "description": "X-ray exam of knee 3",
      "code_information": [
        {
          "code": "73562",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.29,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39.29,
          "maximum": 39.29
        }
      ]
    },
    {
      "description": "X-ray exam knee 4 or more",
      "code_information": [
        {
          "code": "73564",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 45.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 45.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 45.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 45.76,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 45.76,
          "maximum": 45.76
        }
      ]
    },
    {
      "description": "X-ray exam of knees",
      "code_information": [
        {
          "code": "73565",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 38.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 38.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 38.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 38.65,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 38.65,
          "maximum": 38.65
        }
      ]
    },
    {
      "description": "X-ray exam of lower leg",
      "code_information": [
        {
          "code": "73590",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.56,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30.56,
          "maximum": 30.56
        }
      ]
    },
    {
      "description": "X-ray exam of ankle",
      "code_information": [
        {
          "code": "73600",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.88,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30.88,
          "maximum": 30.88
        }
      ]
    },
    {
      "description": "X-ray exam of ankle",
      "code_information": [
        {
          "code": "73610",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 128.52,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 99.96,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 121.38,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 121.38,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 128.52,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 21.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 285.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 285.6,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21.05,
          "maximum": 285.6
        }
      ]
    },
    {
      "description": "X-ray exam of foot",
      "code_information": [
        {
          "code": "73620",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.33,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27.33,
          "maximum": 27.33
        }
      ]
    },
    {
      "description": "X-ray exam of foot",
      "code_information": [
        {
          "code": "73630",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.82,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32.82,
          "maximum": 32.82
        }
      ]
    },
    {
      "description": "X-ray exam of toe(s)",
      "code_information": [
        {
          "code": "73660",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.97,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27.97,
          "maximum": 27.97
        }
      ]
    },
    {
      "description": "Ct lower extremity w/o dye",
      "code_information": [
        {
          "code": "73700",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.35,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 127.35,
          "maximum": 127.35
        }
      ]
    },
    {
      "description": "Ct lower extremity w/dye",
      "code_information": [
        {
          "code": "73701",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 163.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 163.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 163.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 163.41,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 163.41,
          "maximum": 163.41
        }
      ]
    },
    {
      "description": "Mri jnt of lwr extre w/o dye",
      "code_information": [
        {
          "code": "73721",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 199.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 199.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 199.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 199.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 199.47,
          "maximum": 199.47
        }
      ]
    },
    {
      "description": "X-ray exam abdomen 1 view",
      "code_information": [
        {
          "code": "74018",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 114.05,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 88.7,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 107.71,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 107.71,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 114.05,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 24.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 126.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 126.72,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24.06,
          "maximum": 126.72
        }
      ]
    },
    {
      "description": "X-ray exam complete abdomen",
      "code_information": [
        {
          "code": "74022",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 48.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 48.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 48.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 48.27,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 48.27,
          "maximum": 48.27
        }
      ]
    },
    {
      "description": "Ct abdomen w/o dye",
      "code_information": [
        {
          "code": "74150",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 133.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 133.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 133.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 133.73,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 133.73,
          "maximum": 133.73
        }
      ]
    },
    {
      "description": "Ct abdomen w/o & w/dye",
      "code_information": [
        {
          "code": "74170",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 254.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 254.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 254.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 254.54,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 254.54,
          "maximum": 254.54
        }
      ]
    },
    {
      "description": "Ct angio abd&pelv w/o&w/dye",
      "code_information": [
        {
          "code": "74174",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 372.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 372.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 372.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 372.81,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 372.81,
          "maximum": 372.81
        }
      ]
    },
    {
      "description": "Ct angio abdom w/o & w/dye",
      "code_information": [
        {
          "code": "74175",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 300.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 300.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 300.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 300.05,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 300.05,
          "maximum": 300.05
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      ]
    },
    {
      "description": "Ct abd & pelvis w/o contrast",
      "code_information": [
        {
          "code": "74176",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 179.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 179.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 179.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 179.97,
              "methodology": "fee schedule"
            }
          ],
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          "maximum": 179.97
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      ]
    },
    {
      "description": "Ct abd & pelv w/contrast",
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        {
          "code": "74177",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 296.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 1340.46,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 1042.58,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 1265.99,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 296.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 296.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 296.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 1265.99,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 296.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 1340.46,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 296.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 223.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 1489.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 1489.4,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 223.58,
          "maximum": 1489.4
        }
      ]
    },
    {
      "description": "Ct abd & pelv 1/> regns",
      "code_information": [
        {
          "code": "74178",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 331.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 331.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 331.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 331.75,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 331.75,
          "maximum": 331.75
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      ]
    },
    {
      "description": "Mri abdomen w/o dye",
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        {
          "code": "74181",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 191.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 191.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 191.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 191.7,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 191.7,
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      ]
    },
    {
      "description": "Mri abdomen w/o & w/dye",
      "code_information": [
        {
          "code": "74183",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 331.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 331.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 331.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 331.26,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 331.26,
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        }
      ]
    },
    {
      "description": "X-ray xm swlng funcj c+",
      "code_information": [
        {
          "code": "74230",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 117.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 117.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 117.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 117.73,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "X-ray xm sm int 1cntrst std",
      "code_information": [
        {
          "code": "74250",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 116.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 116.03,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 116.03,
          "maximum": 116.03
        }
      ]
    },
    {
      "description": "X-ray bile/panc endoscopy",
      "code_information": [
        {
          "code": "74330",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 25.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 25.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25.71,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25.71,
          "maximum": 25.71
        }
      ]
    },
    {
      "description": "Ct angio hrt w/3d image",
      "code_information": [
        {
          "code": "75574",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 316.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 316.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 316.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 316.94,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 316.94,
          "maximum": 316.94
        }
      ]
    },
    {
      "description": "X-ray aorta leg arteries",
      "code_information": [
        {
          "code": "75630",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 149.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 149.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 149.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 149.44,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 149.44,
          "maximum": 149.44
        }
      ]
    },
    {
      "description": "Ct angio abdominal arteries",
      "code_information": [
        {
          "code": "75635",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 403.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 403.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 403.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 403.22,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 403.22,
          "maximum": 403.22
        }
      ]
    },
    {
      "description": "Artery x-rays arms/legs",
      "code_information": [
        {
          "code": "75716",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 155.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 155.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 155.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 155.59,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 155.59,
          "maximum": 155.59
        }
      ]
    },
    {
      "description": "Artery x-rays abdomen",
      "code_information": [
        {
          "code": "75726",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 164.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 164.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 164.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 164.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 164.09,
          "maximum": 164.09
        }
      ]
    },
    {
      "description": "Vein x-ray arm/leg",
      "code_information": [
        {
          "code": "75820",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 102.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 102.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 102.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 102.19,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 102.19,
          "maximum": 102.19
        }
      ]
    },
    {
      "description": "Vein x-ray arms/legs",
      "code_information": [
        {
          "code": "75822",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 127.56,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 127.56,
          "maximum": 127.56
        }
      ]
    },
    {
      "description": "Vein x-ray trunk",
      "code_information": [
        {
          "code": "75825",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 109.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 109.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 109.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 109.27,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 109.27,
          "maximum": 109.27
        }
      ]
    },
    {
      "description": "Vein x-ray chest",
      "code_information": [
        {
          "code": "75827",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 112.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 112.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 112.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 112.68,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 112.68,
          "maximum": 112.68
        }
      ]
    },
    {
      "description": "Fluoroscopy <1 hr phys/qhp",
      "code_information": [
        {
          "code": "76000",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.39,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 41.39,
          "maximum": 41.39
        }
      ]
    },
    {
      "description": "X-ray exam surgical specimen",
      "code_information": [
        {
          "code": "76098",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 41.47,
          "maximum": 41.47
        }
      ]
    },
    {
      "description": "Cat scan follow-up study",
      "code_information": [
        {
          "code": "76380",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 128.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 128.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 128.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 128.23,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 128.23,
          "maximum": 128.23
        }
      ]
    },
    {
      "description": "Echo exam of eye thickness",
      "code_information": [
        {
          "code": "76514",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 10.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 10.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 10.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 10.83,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 10.83,
          "maximum": 10.83
        }
      ]
    },
    {
      "description": "Us exam of head and neck",
      "code_information": [
        {
          "code": "76536",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 105.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 105.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 105.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 105.67,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 105.67,
          "maximum": 105.67
        }
      ]
    },
    {
      "description": "Ultrasound breast complete",
      "code_information": [
        {
          "code": "76641",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 98.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 98.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 98.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 98.56,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 98.56,
          "maximum": 98.56
        }
      ]
    },
    {
      "description": "Us exam abdom complete",
      "code_information": [
        {
          "code": "76700",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 111.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 537.05,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 417.7,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 507.21,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 111.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 111.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 111.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 507.21,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 111.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 537.05,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 111.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 91.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 596.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 596.72,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 91.57,
          "maximum": 596.72
        }
      ]
    },
    {
      "description": "Echo exam of abdomen",
      "code_information": [
        {
          "code": "76705",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 83.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 83.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 83.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 83.76,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 83.76,
          "maximum": 83.76
        }
      ]
    },
    {
      "description": "Us exam abdo back wall comp",
      "code_information": [
        {
          "code": "76770",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 103.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 103.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 103.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 103.97,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 103.97,
          "maximum": 103.97
        }
      ]
    },
    {
      "description": "Ob us < 14 wks single fetus",
      "code_information": [
        {
          "code": "76801",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 112.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 112.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 112.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 112.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 112.47,
          "maximum": 112.47
        }
      ]
    },
    {
      "description": "Ob us >= 14 wks sngl fetus",
      "code_information": [
        {
          "code": "76805",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 129.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 129.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 129.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 129.53,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 129.53,
          "maximum": 129.53
        }
      ]
    },
    {
      "description": "Ob us detailed sngl fetus",
      "code_information": [
        {
          "code": "76811",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 171.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 171.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 171.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 171.49,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 171.49,
          "maximum": 171.49
        }
      ]
    },
    {
      "description": "Ob us limited fetus(s)",
      "code_information": [
        {
          "code": "76815",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 77.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 77.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 77.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 77.94,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 77.94,
          "maximum": 77.94
        }
      ]
    },
    {
      "description": "Transvaginal us obstetric",
      "code_information": [
        {
          "code": "76817",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 88.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 88.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 88.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 88.62,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 88.62,
          "maximum": 88.62
        }
      ]
    },
    {
      "description": "Fetal biophys profile w/nst",
      "code_information": [
        {
          "code": "76818",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 114.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 114.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 114.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 114.73,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 114.73,
          "maximum": 114.73
        }
      ]
    },
    {
      "description": "Fetal biophys profil w/o nst",
      "code_information": [
        {
          "code": "76819",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 82.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 82.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 82.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 82.79,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 82.79,
          "maximum": 82.79
        }
      ]
    },
    {
      "description": "Transvaginal us non-ob",
      "code_information": [
        {
          "code": "76830",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 113.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 113.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 113.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 113.76,
          "maximum": 113.76
        }
      ]
    },
    {
      "description": "Us exam pelvic complete",
      "code_information": [
        {
          "code": "76856",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 101.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 101.15,
          "maximum": 101.15
        }
      ]
    },
    {
      "description": "Us exam scrotum",
      "code_information": [
        {
          "code": "76870",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 96.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 96.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 96.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 96.29,
          "maximum": 96.29
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      ]
    },
    {
      "description": "Us transrectal",
      "code_information": [
        {
          "code": "76872",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 190.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 190.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 190.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 190.18,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 190.18,
          "maximum": 190.18
        }
      ]
    },
    {
      "description": "Us guide vascular access",
      "code_information": [
        {
          "code": "76937",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 36.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 36.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 36.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 36.95,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 36.95,
          "maximum": 36.95
        }
      ]
    },
    {
      "description": "Echo guide for transfusion",
      "code_information": [
        {
          "code": "76941",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 60.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 60.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 60.88,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 60.88,
          "maximum": 60.88
        }
      ]
    },
    {
      "description": "Echo guide for biopsy",
      "code_information": [
        {
          "code": "76942",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 56.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            }
          ],
          "minimum": 56.92,
          "maximum": 56.92
        }
      ]
    },
    {
      "description": "Fluoroguide for vein device",
      "code_information": [
        {
          "code": "77001",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 93.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 93.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 93.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 93.71,
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      ]
    },
    {
      "description": "Needle localization by xray",
      "code_information": [
        {
          "code": "77002",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            }
          ],
          "minimum": 109.96,
          "maximum": 109.96
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      ]
    },
    {
      "description": "Ct scan for needle biopsy",
      "code_information": [
        {
          "code": "77012",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 121.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 121.51,
          "maximum": 121.51
        }
      ]
    },
    {
      "description": "Dx mammo incl cad uni",
      "code_information": [
        {
          "code": "77065",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 121.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 121.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 121.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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          "maximum": 121.44
        }
      ]
    },
    {
      "description": "Dx mammo incl cad bi",
      "code_information": [
        {
          "code": "77066",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 153.14,
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        }
      ]
    },
    {
      "description": "Scr mammo bi incl cad",
      "code_information": [
        {
          "code": "77067",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "estimated_amount": 124.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 124.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 124.11,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 124.11,
          "maximum": 124.11
        }
      ]
    },
    {
      "description": "Dxa bone density axial",
      "code_information": [
        {
          "code": "77080",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 38,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 38,
          "maximum": 38
        }
      ]
    },
    {
      "description": "Set radiation therapy field",
      "code_information": [
        {
          "code": "77280",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 259.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 259.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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        }
      ]
    },
    {
      "description": "Set radiation therapy field",
      "code_information": [
        {
          "code": "77290",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 426.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 426.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 426.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 426.86,
              "methodology": "fee schedule"
            }
          ],
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        }
      ]
    },
    {
      "description": "3-d radiotherapy plan",
      "code_information": [
        {
          "code": "77295",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 469.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 469.91,
              "methodology": "fee schedule"
            },
            {
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              "standard_charge_percentage": 100,
              "estimated_amount": 469.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 469.91,
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        }
      ]
    },
    {
      "description": "Radiation therapy dose plan",
      "code_information": [
        {
          "code": "77300",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 65,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 65,
          "maximum": 65
        }
      ]
    },
    {
      "description": "Telethx isodose plan cplx",
      "code_information": [
        {
          "code": "77307",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 281.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 281.92,
              "methodology": "fee schedule"
            },
            {
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      "description": "Radiation treatment aid(s)",
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          "code": "77332",
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      "description": "Radiation physics consult",
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          "code": "77338",
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      "description": "Radiology port images(s)",
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          "code": "77417",
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      "description": "Thyroid met imaging body",
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        {
          "code": "78018",
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        {
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      "description": "Hepatobiliary system imaging",
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        {
          "code": "78226",
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      "description": "Gastric emptying imag study",
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          "code": "78264",
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      ],
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        {
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      "description": "Bone imaging whole body",
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        {
          "code": "78306",
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      ],
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        {
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      "description": "Ht muscle image spect sing",
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        {
          "code": "78451",
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      ],
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        {
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      "description": "Ht muscle image spect mult",
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      ],
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      "description": "Metabolic panel total ca",
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        {
          "code": "80048",
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      ],
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        {
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "Medicaid (State)",
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            },
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    {
      "description": "Comprehen metabolic panel",
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          "setting": "outpatient",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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      "description": "Lipid panel",
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      ],
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        {
          "setting": "outpatient",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Renal function panel",
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        {
          "code": "80069",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            },
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              "methodology": "percent of total billed charges"
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              "payer_name": "Wise Provider Networks",
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              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 70.17,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "estimated_amount": 8.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 8.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 7.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 82.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 82.55,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 7.81,
          "maximum": 82.55
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      ]
    },
    {
      "description": "Acute hepatitis panel",
      "code_information": [
        {
          "code": "80074",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 47.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 47.63,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 47.63,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 47.63,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 47.63,
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      ]
    },
    {
      "description": "Hepatic function panel",
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        {
          "code": "80076",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.17,
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Drug assay acetaminophen",
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        {
          "code": "80143",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "estimated_amount": 18.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 18.64,
              "methodology": "fee schedule"
            },
            {
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              "estimated_amount": 18.64,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 18.64,
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            }
          ],
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      ]
    },
    {
      "description": "Assay of digoxin free",
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        {
          "code": "80163",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "estimated_amount": 13.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 13.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            }
          ],
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      ]
    },
    {
      "description": "Dipropylacetic acid free",
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        {
          "code": "80165",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Drug scrn quan levetiracetam",
      "code_information": [
        {
          "code": "80177",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 13.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 13.25,
              "methodology": "fee schedule"
            }
          ],
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          "maximum": 13.25
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      ]
    },
    {
      "description": "Drug assay salicylate",
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        {
          "code": "80179",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 18.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Assay of phenobarbital",
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        {
          "code": "80184",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 15.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            }
          ],
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      ]
    },
    {
      "description": "Assay of phenytoin total",
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        {
          "code": "80185",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 13.25,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 13.25,
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            }
          ],
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          "maximum": 13.25
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      ]
    },
    {
      "description": "Assay of vancomycin",
      "code_information": [
        {
          "code": "80202",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 13.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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            },
            {
              "payer_name": "Medicaid (State)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 12.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 128.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 128.8,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 12.19,
          "maximum": 128.8
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      ]
    },
    {
      "description": "Drug test prsmv dir opt obs",
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        {
          "code": "80305",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 12.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 12.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 12.6,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 12.6,
          "maximum": 12.6
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      ]
    },
    {
      "description": "Drug test prsmv chem anlyzr",
      "code_information": [
        {
          "code": "80307",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 62.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 62.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 62.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 62.14,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 62.14,
          "maximum": 62.14
        }
      ]
    },
    {
      "description": "Urinalysis auto w/scope",
      "code_information": [
        {
          "code": "81001",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
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              "standard_charge_percentage": 90,
              "estimated_amount": 0.9,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "standard_charge_percentage": 70,
              "estimated_amount": 0.7,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 0.85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 3.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
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              "standard_charge_percentage": 85,
              "estimated_amount": 0.85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 3.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 0.9,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 2.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.1,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 0.7,
          "maximum": 30.1
        }
      ]
    },
    {
      "description": "Urinalysis auto w/o scope",
      "code_information": [
        {
          "code": "81003",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 2.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
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              "estimated_amount": 2.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 2.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "estimated_amount": 2.25,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 2.25,
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        }
      ]
    },
    {
      "description": "Microscopic exam of urine",
      "code_information": [
        {
          "code": "81015",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 3.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 3.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 3.05,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 3.05,
          "maximum": 3.05
        }
      ]
    },
    {
      "description": "Urine pregnancy test",
      "code_information": [
        {
          "code": "81025",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
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              "estimated_amount": 8.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 8.61,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 8.61,
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      ]
    },
    {
      "description": "Acetone assay",
      "code_information": [
        {
          "code": "82010",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.17,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.17,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 8.17,
          "maximum": 8.17
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      ]
    },
    {
      "description": "Assay of serum albumin",
      "code_information": [
        {
          "code": "82040",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.95,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4.95,
          "maximum": 4.95
        }
      ]
    },
    {
      "description": "Alpha-fetoprotein serum",
      "code_information": [
        {
          "code": "82105",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 16.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 16.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16.77,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16.77,
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        }
      ]
    },
    {
      "description": "Assay of ammonia",
      "code_information": [
        {
          "code": "82140",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 14.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 14.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 14.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 14.57,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 14.57,
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        }
      ]
    },
    {
      "description": "Assay of amylase",
      "code_information": [
        {
          "code": "82150",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 6.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 6.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 6.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 6.48,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 6.48,
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        }
      ]
    },
    {
      "description": "Assay of beta-2 protein",
      "code_information": [
        {
          "code": "82232",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 16.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 16.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 16.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 16.18,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16.18,
          "maximum": 16.18
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      ]
    },
    {
      "description": "Bilirubin direct",
      "code_information": [
        {
          "code": "82248",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 5.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 5.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 5.02,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 5.02,
          "maximum": 5.02
        }
      ]
    },
    {
      "description": "Occult bld feces 1-3 tests",
      "code_information": [
        {
          "code": "82272",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 4.23,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4.23,
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      ]
    },
    {
      "description": "Vitamin d 25 hydroxy",
      "code_information": [
        {
          "code": "82306",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 29.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 29.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 29.6,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 29.6,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29.6,
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      ]
    },
    {
      "description": "Assay of calcium",
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        {
          "code": "82330",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
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              "standard_charge_percentage": 90,
              "estimated_amount": 116.96,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "standard_charge_percentage": 70,
              "estimated_amount": 90.97,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 110.46,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 13.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
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              "standard_charge_percentage": 85,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
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              "standard_charge_percentage": 90,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 13.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 12.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 129.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 129.95,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 12.31,
          "maximum": 129.95
        }
      ]
    },
    {
      "description": "Calculus assay quant",
      "code_information": [
        {
          "code": "82360",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 12.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 12.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 12.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 12.87,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 12.87,
          "maximum": 12.87
        }
      ]
    },
    {
      "description": "Carcinoembryonic antigen",
      "code_information": [
        {
          "code": "82378",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 18.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 18.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 18.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18.96,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18.96,
          "maximum": 18.96
        }
      ]
    },
    {
      "description": "Total cortisol",
      "code_information": [
        {
          "code": "82533",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 16.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16.3,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16.3,
          "maximum": 16.3
        }
      ]
    },
    {
      "description": "Assay of ck (cpk)",
      "code_information": [
        {
          "code": "82550",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.51,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 6.51,
          "maximum": 6.51
        }
      ]
    },
    {
      "description": "Creatine mb fraction",
      "code_information": [
        {
          "code": "82553",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 11.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 11.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 11.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 11.55,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 11.55,
          "maximum": 11.55
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      ]
    },
    {
      "description": "Assay of creatinine",
      "code_information": [
        {
          "code": "82565",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.12,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 5.12,
          "maximum": 5.12
        }
      ]
    },
    {
      "description": "Assay of urine creatinine",
      "code_information": [
        {
          "code": "82570",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 5.18,
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        }
      ]
    },
    {
      "description": "Vitamin b-12",
      "code_information": [
        {
          "code": "82607",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 15.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 15.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 15.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 15.08,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15.08,
          "maximum": 15.08
        }
      ]
    },
    {
      "description": "Assay of erythropoietin",
      "code_information": [
        {
          "code": "82668",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 18.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 18.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18.79,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18.79,
          "maximum": 18.79
        }
      ]
    },
    {
      "description": "Assay of ferritin",
      "code_information": [
        {
          "code": "82728",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 13.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 116.6,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 90.69,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 110.12,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
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              "estimated_amount": 13.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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              "estimated_amount": 13.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 13.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 12.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 129.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 129.55,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 12.27,
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        }
      ]
    },
    {
      "description": "Assay of folic acid serum",
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        {
          "code": "82746",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 14.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 14.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 14.7,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 14.7,
          "maximum": 14.7
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      ]
    },
    {
      "description": "Assay iga/igd/igg/igm each",
      "code_information": [
        {
          "code": "82784",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 9.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 9.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 9.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 9.3,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 9.3,
          "maximum": 9.3
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      ]
    },
    {
      "description": "Blood gases any combination",
      "code_information": [
        {
          "code": "82803",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "estimated_amount": 26.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 165.56,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 128.77,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 156.36,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 26.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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              "estimated_amount": 26.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 26.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 26.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 165.56,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 26.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 23.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 183.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 183.95,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23.73,
          "maximum": 183.95
        }
      ]
    },
    {
      "description": "Blood gases w/o2 saturation",
      "code_information": [
        {
          "code": "82805",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 78.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
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              "standard_charge_percentage": 90,
              "estimated_amount": 242.87,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 188.9,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 229.37,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 78.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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              "estimated_amount": 78.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 78.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 229.37,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 78.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
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              "standard_charge_percentage": 90,
              "estimated_amount": 242.87,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 78.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 34.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 269.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 269.85,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34.8,
          "maximum": 269.85
        }
      ]
    },
    {
      "description": "Glucose other fluid",
      "code_information": [
        {
          "code": "82945",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 33.57,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 26.11,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 31.71,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 3.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 31.71,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 33.57,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 3.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.3,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 3.54,
          "maximum": 37.3
        }
      ]
    },
    {
      "description": "Assay glucose blood quant",
      "code_information": [
        {
          "code": "82947",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.93,
              "methodology": "fee schedule"
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          ],
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    {
      "description": "Reagent strip/blood glucose",
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        {
          "code": "82948",
          "type": "HCPCS"
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      ],
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          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "payer_name": "Medicaid (State)",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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    },
    {
      "description": "Assay of ggt",
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        {
          "code": "82977",
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      ],
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        {
          "setting": "outpatient",
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      ]
    },
    {
      "description": "Assay of haptoglobin quant",
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        {
          "code": "83010",
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        }
      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
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    },
    {
      "description": "Hemoglobin glycosylated a1c",
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        {
          "code": "83036",
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      ],
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        {
          "setting": "outpatient",
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              "payer_name": "Wise Provider Networks",
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              "payer_name": "Cigna Health and Life Insurance Company",
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              "payer_name": "Medicaid (State)",
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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          ],
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      ]
    },
    {
      "description": "Iron binding test",
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        {
          "code": "83550",
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      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ]
    },
    {
      "description": "Assay of lactic acid",
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        {
          "code": "83605",
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      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
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    {
      "description": "Lactate (ld) (ldh) enzyme",
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        {
          "code": "83615",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Assay of lipase",
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        {
          "code": "83690",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Assay of magnesium",
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        {
          "code": "83735",
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      ],
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        {
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              "payer_name": "Wise Provider Networks",
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              "payer_name": "Cigna Health and Life Insurance Company",
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "payer_name": "Medicaid (State)",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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          ],
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    },
    {
      "description": "Assay of natriuretic peptide",
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        {
          "code": "83880",
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      ],
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        {
          "setting": "outpatient",
          "payers_information": [
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              "payer_name": "United Healthcare (UHC)",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Cigna Health and Life Insurance Company",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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            },
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            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Assay of blood osmolality",
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        {
          "code": "83930",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 6.61,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 6.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Assay of urine osmolality",
      "code_information": [
        {
          "code": "83935",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
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              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 6.82,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 6.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 6.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.82,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 6.82,
          "maximum": 6.82
        }
      ]
    },
    {
      "description": "Assay of parathormone",
      "code_information": [
        {
          "code": "83970",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.28,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 41.28,
          "maximum": 41.28
        }
      ]
    },
    {
      "description": "Assay of phosphorus",
      "code_information": [
        {
          "code": "84100",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 40.59,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 31.57,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 38.34,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 38.34,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 40.59,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 45.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 45.1,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4.27,
          "maximum": 45.1
        }
      ]
    },
    {
      "description": "Assay of serum potassium",
      "code_information": [
        {
          "code": "84132",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.76,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4.76,
          "maximum": 4.76
        }
      ]
    },
    {
      "description": "Assay of prealbumin",
      "code_information": [
        {
          "code": "84134",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 124.79,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 97.06,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 117.85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 117.85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 124.79,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 13.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 138.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 138.65,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 13.13,
          "maximum": 138.65
        }
      ]
    },
    {
      "description": "Procalcitonin (pct)",
      "code_information": [
        {
          "code": "84145",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 183.35,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 142.6,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 173.16,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 173.16,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 183.35,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 24.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 203.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 203.72,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24.36,
          "maximum": 203.72
        }
      ]
    },
    {
      "description": "Assay of psa total",
      "code_information": [
        {
          "code": "84153",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 18.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 18.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18.39,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18.39,
          "maximum": 18.39
        }
      ]
    },
    {
      "description": "Assay of protein serum",
      "code_information": [
        {
          "code": "84155",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.67,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 3.67,
          "maximum": 3.67
        }
      ]
    },
    {
      "description": "Assay of protein urine",
      "code_information": [
        {
          "code": "84156",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.67,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 3.67,
          "maximum": 3.67
        }
      ]
    },
    {
      "description": "Assay of protein other",
      "code_information": [
        {
          "code": "84157",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4,
          "maximum": 4
        }
      ]
    },
    {
      "description": "Protein e-phoresis serum",
      "code_information": [
        {
          "code": "84165",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 15.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 15.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 15.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 15.83,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15.83,
          "maximum": 15.83
        }
      ]
    },
    {
      "description": "Assay of serum sodium",
      "code_information": [
        {
          "code": "84295",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.81,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4.81,
          "maximum": 4.81
        }
      ]
    },
    {
      "description": "Assay of urine sodium",
      "code_information": [
        {
          "code": "84300",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.06,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 5.06,
          "maximum": 5.06
        }
      ]
    },
    {
      "description": "Assay of total testosterone",
      "code_information": [
        {
          "code": "84403",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 25.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 25.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25.81,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25.81,
          "maximum": 25.81
        }
      ]
    },
    {
      "description": "Assay of total thyroxine",
      "code_information": [
        {
          "code": "84436",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 6.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Assay of free thyroxine",
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        {
          "code": "84439",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 9.02,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 9.02,
              "methodology": "fee schedule"
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              "estimated_amount": 9.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Assay thyroid stim hormone",
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        {
          "code": "84443",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 16.8,
              "methodology": "fee schedule"
            },
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              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "standard_charge_percentage": 70,
              "estimated_amount": 111.83,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
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              "estimated_amount": 135.79,
              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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            },
            {
              "payer_name": "Coventry Health Care",
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            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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            },
            {
              "payer_name": "Cofinity",
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              "standard_charge_percentage": 90,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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            },
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              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
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              "estimated_amount": 15.12,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 159.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 159.75,
              "methodology": "fee schedule"
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          ],
          "minimum": 15.12,
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      ]
    },
    {
      "description": "Assay of transferrin",
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        {
          "code": "84466",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 12.76,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 12.76,
              "methodology": "fee schedule"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
          "minimum": 12.76,
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      ]
    },
    {
      "description": "Assay of triglycerides",
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        {
          "code": "84478",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 5.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Assay of thyroid (t3 or t4)",
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        {
          "code": "84479",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 6.47,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Assay triiodothyronine (t3)",
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        {
          "code": "84480",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 14.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 14.18,
              "methodology": "fee schedule"
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Free assay (ft-3)",
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        {
          "code": "84481",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            },
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              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Medicare (CMS)",
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            },
            {
              "payer_name": "Medicaid (State)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 161.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 15.25,
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      ]
    },
    {
      "description": "Assay of troponin quant",
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        {
          "code": "84484",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 12.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Assay of urea nitrogen",
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        {
          "code": "84520",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 3.95,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 3.95,
              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 3.95,
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      ]
    },
    {
      "description": "Assay of blood/uric acid",
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        {
          "code": "84550",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 4.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 4.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Chorionic gonadotropin test",
      "code_information": [
        {
          "code": "84702",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 15.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 15.05,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 15.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 15.05,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15.05,
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      ]
    },
    {
      "description": "Chorionic gonadotropin assay",
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        {
          "code": "84703",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 7.52,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 7.52,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
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      ]
    },
    {
      "description": "Bl smear w/diff wbc count",
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        {
          "code": "85007",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 3.8,
              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
            {
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              "estimated_amount": 3.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 3.8,
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      ]
    },
    {
      "description": "Bl smear w/o diff wbc count",
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        {
          "code": "85008",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 3.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 3.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 3.43,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 3.43,
          "maximum": 3.43
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      ]
    },
    {
      "description": "Hematocrit",
      "code_information": [
        {
          "code": "85014",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 2.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 2.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 2.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 2.37,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 2.37,
          "maximum": 2.37
        }
      ]
    },
    {
      "description": "Hemoglobin",
      "code_information": [
        {
          "code": "85018",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 2.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 2.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 2.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 2.37,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 2.37,
          "maximum": 2.37
        }
      ]
    },
    {
      "description": "Complete cbc w/auto diff wbc",
      "code_information": [
        {
          "code": "85025",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 7.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 66.56,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 51.77,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 62.86,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 7.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 7.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 7.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 62.86,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 7.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 66.56,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 7.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 73.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 73.95,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 6.99,
          "maximum": 73.95
        }
      ]
    },
    {
      "description": "Complete cbc automated",
      "code_information": [
        {
          "code": "85027",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 55.4,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 43.09,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 52.32,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 52.32,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 55.4,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 61.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 61.55,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 5.82,
          "maximum": 61.55
        }
      ]
    },
    {
      "description": "Manual reticulocyte count",
      "code_information": [
        {
          "code": "85044",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.31,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4.31,
          "maximum": 4.31
        }
      ]
    },
    {
      "description": "Automated platelet count",
      "code_information": [
        {
          "code": "85049",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.48,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4.48,
          "maximum": 4.48
        }
      ]
    },
    {
      "description": "Bone marrow interpretation",
      "code_information": [
        {
          "code": "85097",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 44.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 44.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 44.95,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 44.95,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 44.95,
          "maximum": 44.95
        }
      ]
    },
    {
      "description": "Coagulation time activated",
      "code_information": [
        {
          "code": "85347",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.28,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4.28,
          "maximum": 4.28
        }
      ]
    },
    {
      "description": "Fibrin degradation products",
      "code_information": [
        {
          "code": "85362",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.89,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 6.89,
          "maximum": 6.89
        }
      ]
    },
    {
      "description": "Fibrin degradation quant",
      "code_information": [
        {
          "code": "85379",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 10.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 10.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 10.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 10.18,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 10.18,
          "maximum": 10.18
        }
      ]
    },
    {
      "description": "Fibrinogen activity",
      "code_information": [
        {
          "code": "85384",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 9.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 9.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 9.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 9.72,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 9.72,
          "maximum": 9.72
        }
      ]
    },
    {
      "description": "Blood platelet aggregation",
      "code_information": [
        {
          "code": "85576",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 24.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 24.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 24.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24.91,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24.91,
          "maximum": 24.91
        }
      ]
    },
    {
      "description": "Prothrombin time",
      "code_information": [
        {
          "code": "85610",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 33.62,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 26.15,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 31.75,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 31.75,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 33.62,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.35,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 3.86,
          "maximum": 37.35
        }
      ]
    },
    {
      "description": "Rbc sed rate nonautomated",
      "code_information": [
        {
          "code": "85651",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
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            }
          ],
          "minimum": 4.27,
          "maximum": 4.27
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      ]
    },
    {
      "description": "Thromboplastin time partial",
      "code_information": [
        {
          "code": "85730",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 6.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.01,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 6.01,
          "maximum": 6.01
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      ]
    },
    {
      "description": "Platelet antibodies",
      "code_information": [
        {
          "code": "86022",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 18.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
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              "estimated_amount": 18.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 18.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "estimated_amount": 18.37,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18.37,
          "maximum": 18.37
        }
      ]
    },
    {
      "description": "Antinuclear antibodies",
      "code_information": [
        {
          "code": "86038",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 12.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 12.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 12.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 12.09,
              "methodology": "fee schedule"
            }
          ],
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          "maximum": 12.09
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      ]
    },
    {
      "description": "C-reactive protein",
      "code_information": [
        {
          "code": "86140",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 44.28,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 34.44,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 41.82,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 5.18,
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            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 41.82,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 44.28,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 49.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4.66,
          "maximum": 49.2
        }
      ]
    },
    {
      "description": "Dna antibody native",
      "code_information": [
        {
          "code": "86225",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 13.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 13.74,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 13.74,
          "maximum": 13.74
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      ]
    },
    {
      "description": "Nuclear antigen antibody",
      "code_information": [
        {
          "code": "86235",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 17.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 17.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 17.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 17.93,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17.93,
          "maximum": 17.93
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      ]
    },
    {
      "description": "Fluorescent antibody titer",
      "code_information": [
        {
          "code": "86256",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 15.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 15.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 15.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 15.83,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15.83,
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      ]
    },
    {
      "description": "Immunoassay tumor ca 15-3",
      "code_information": [
        {
          "code": "86300",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 20.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 20.81,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 20.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 20.81,
          "maximum": 20.81
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      ]
    },
    {
      "description": "Immunoassay tumor ca 19-9",
      "code_information": [
        {
          "code": "86301",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 20.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 20.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 20.81,
              "methodology": "fee schedule"
            }
          ],
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        }
      ]
    },
    {
      "description": "Immunoassay tumor ca 125",
      "code_information": [
        {
          "code": "86304",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 20.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 20.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 20.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 20.81,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Rheumatoid factor quant",
      "code_information": [
        {
          "code": "86431",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 5.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 5.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 5.67,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 5.67,
          "maximum": 5.67
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      ]
    },
    {
      "description": "Tb test cell immun measure",
      "code_information": [
        {
          "code": "86480",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 61.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 61.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 61.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 61.98,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 61.98,
          "maximum": 61.98
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      ]
    },
    {
      "description": "Syphilis test non-trep qual",
      "code_information": [
        {
          "code": "86592",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Herpes simplex nes antbdy",
      "code_information": [
        {
          "code": "86694",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 14.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 14.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 14.39,
              "methodology": "fee schedule"
            }
          ],
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        }
      ]
    },
    {
      "description": "Herpes simplex type 1 test",
      "code_information": [
        {
          "code": "86695",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 13.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 13.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.19,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 13.19,
          "maximum": 13.19
        }
      ]
    },
    {
      "description": "Herpes simplex type 2 test",
      "code_information": [
        {
          "code": "86696",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 19.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 19.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 19.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19.35,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19.35,
          "maximum": 19.35
        }
      ]
    },
    {
      "description": "Hep b core antibody igm",
      "code_information": [
        {
          "code": "86705",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 11.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 11.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 11.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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          "maximum": 11.77
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      ]
    },
    {
      "description": "Hep b surface antibody",
      "code_information": [
        {
          "code": "86706",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 10.74,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Lymph choriomeningitis ab",
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        {
          "code": "86727",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 12.87,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Mumps antibody",
      "code_information": [
        {
          "code": "86735",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 13.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 13.05,
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Rubeola antibody",
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        {
          "code": "86765",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 12.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Treponema pallidum",
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        {
          "code": "86780",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "estimated_amount": 13.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 13.24,
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            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Varicella-zoster antibody",
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        {
          "code": "86787",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Rbc antibody screen",
      "code_information": [
        {
          "code": "86850",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Coombs test direct",
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        {
          "code": "86880",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 5.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 5.39,
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            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Blood typing serologic abo",
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        {
          "code": "86900",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 2.99,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 2.99,
              "methodology": "fee schedule"
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 2.99,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            }
          ],
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      ]
    },
    {
      "description": "Blood typing serologic rh(d)",
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        {
          "code": "86901",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 2.99,
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            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 2.99,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Blood typing rbc antigens",
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        {
          "code": "86905",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 3.83,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 3.83,
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            },
            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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            },
            {
              "payer_name": "Medicaid (State)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 36.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 36.35,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 3.83,
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      ]
    },
    {
      "description": "Bld typing serologic rh phnt",
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        {
          "code": "86906",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 7.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 7.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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          ],
          "minimum": 7.75,
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      ]
    },
    {
      "description": "Blood culture for bacteria",
      "code_information": [
        {
          "code": "87040",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 10.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 10.32,
              "methodology": "fee schedule"
            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 10.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 9.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 98.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 98.15,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Feces culture aerobic bact",
      "code_information": [
        {
          "code": "87045",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Stool cultr aerobic bact ea",
      "code_information": [
        {
          "code": "87046",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 9.44,
              "methodology": "fee schedule"
            }
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      ]
    },
    {
      "description": "Culture othr specimn aerobic",
      "code_information": [
        {
          "code": "87070",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
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              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 57.33,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 69.62,
              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.62,
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
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              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 8.62,
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            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
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              "methodology": "percent of total billed charges"
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            {
              "payer_name": "Medicare (CMS)",
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            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 7.76,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 81.9,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 81.9,
              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Cultr bacteria except blood",
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        {
          "code": "87075",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 9.47,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 9.47,
              "methodology": "fee schedule"
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            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 9.47,
              "methodology": "fee schedule"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 9.47,
              "methodology": "fee schedule"
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          ],
          "minimum": 9.47,
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      ]
    },
    {
      "description": "Culture anaerobe ident each",
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        {
          "code": "87076",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Culture aerobic identify",
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        {
          "code": "87077",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 8.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 8.08,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 8.08,
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      ]
    },
    {
      "description": "Urine culture/colony count",
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        {
          "code": "87086",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 8.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 8.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 8.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 8.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 7.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 76.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 76.75,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 7.26,
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      ]
    },
    {
      "description": "Urine bacteria culture",
      "code_information": [
        {
          "code": "87088",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 8.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 8.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 8.09,
          "maximum": 8.09
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      ]
    },
    {
      "description": "Skin fungi culture",
      "code_information": [
        {
          "code": "87101",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 7.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 7.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 7.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 7.71,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 7.71,
          "maximum": 7.71
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      ]
    },
    {
      "description": "Fungi identification yeast",
      "code_information": [
        {
          "code": "87106",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 10.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 10.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 10.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 10.32,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 10.32,
          "maximum": 10.32
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      ]
    },
    {
      "description": "Mycobacteria culture",
      "code_information": [
        {
          "code": "87116",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 10.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 10.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 10.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 10.8,
          "maximum": 10.8
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      ]
    },
    {
      "description": "Culture type immunologic",
      "code_information": [
        {
          "code": "87147",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 5.18,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 5.18,
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      ]
    },
    {
      "description": "Dna/rna amplified probe",
      "code_information": [
        {
          "code": "87150",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 35.09,
          "maximum": 35.09
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      ]
    },
    {
      "description": "Microbe susceptible diffuse",
      "code_information": [
        {
          "code": "87181",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 4.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.75,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4.75,
          "maximum": 4.75
        }
      ]
    },
    {
      "description": "Microbe susceptible disk",
      "code_information": [
        {
          "code": "87184",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 7.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 7.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 7.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 7.48,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 7.48,
          "maximum": 7.48
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      ]
    },
    {
      "description": "Microbe susceptible mic",
      "code_information": [
        {
          "code": "87186",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 8.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 8.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 8.65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 8.65,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 8.65,
          "maximum": 8.65
        }
      ]
    },
    {
      "description": "Smear gram stain",
      "code_information": [
        {
          "code": "87205",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.27,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4.27,
          "maximum": 4.27
        }
      ]
    },
    {
      "description": "Smear wet mount saline/ink",
      "code_information": [
        {
          "code": "87210",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 5.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 5.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 5.82,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 5.82,
          "maximum": 5.82
        }
      ]
    },
    {
      "description": "Aspergillus ag ia",
      "code_information": [
        {
          "code": "87305",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 11.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Clostridium ag ia",
      "code_information": [
        {
          "code": "87324",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 11.98,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 11.98,
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            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 11.98,
              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Cryptococcus neoform ag ia",
      "code_information": [
        {
          "code": "87327",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 13.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 13.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 13.42,
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          ],
          "minimum": 13.42,
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      ]
    },
    {
      "description": "Hepatitis b surface ag ia",
      "code_information": [
        {
          "code": "87340",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 10.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 88.38,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 83.47,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 10.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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              "estimated_amount": 10.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 10.33,
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            },
            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 10.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
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              "estimated_amount": 10.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 9.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 98.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 98.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 9.3,
          "maximum": 98.2
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      ]
    },
    {
      "description": "Resp syncytial virus ag ia",
      "code_information": [
        {
          "code": "87420",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 13.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 13.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.91,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 13.91,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 13.91,
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      ]
    },
    {
      "description": "Sarscov coronavirus ag ia",
      "code_information": [
        {
          "code": "87426",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 35.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 35.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35.33,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 35.33,
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      ]
    },
    {
      "description": "Shiga-like toxin ag ia",
      "code_information": [
        {
          "code": "87427",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 11.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 11.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 11.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 11.98,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Nos each organism ag ia",
      "code_information": [
        {
          "code": "87449",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 11.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 11.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 11.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 11.98,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 11.98,
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      ]
    },
    {
      "description": "Chlmyd trach dna dir probe",
      "code_information": [
        {
          "code": "87490",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.75,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22.75,
          "maximum": 22.75
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      ]
    },
    {
      "description": "Chlmyd trach dna amp probe",
      "code_information": [
        {
          "code": "87491",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
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              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 35.09,
          "maximum": 35.09
        }
      ]
    },
    {
      "description": "Influenza dna amp probe",
      "code_information": [
        {
          "code": "87502",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 95.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 95.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 95.8,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 95.8,
          "maximum": 95.8
        }
      ]
    },
    {
      "description": "Hepatitis c revrs trnscrpj",
      "code_information": [
        {
          "code": "87522",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 42.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 42.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 42.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 42.84,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 42.84,
          "maximum": 42.84
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      ]
    },
    {
      "description": "Hsv dna amp probe",
      "code_information": [
        {
          "code": "87529",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            }
          ],
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        }
      ]
    },
    {
      "description": "Hiv-1 quant&revrse trnscrpj",
      "code_information": [
        {
          "code": "87536",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 85.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 85.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 85.1,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 85.1,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 85.1,
          "maximum": 85.1
        }
      ]
    },
    {
      "description": "M.tuberculo dna amp probe",
      "code_information": [
        {
          "code": "87556",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 41.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 41.68,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 41.68,
          "maximum": 41.68
        }
      ]
    },
    {
      "description": "N.gonorrhoeae dna amp prob",
      "code_information": [
        {
          "code": "87591",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 35.09,
          "maximum": 35.09
        }
      ]
    },
    {
      "description": "Sars-cov-2 covid-19 amp prb",
      "code_information": [
        {
          "code": "87635",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 51.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 135,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 105,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 127.5,
              "methodology": "percent of total billed charges"
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              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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            },
            {
              "payer_name": "Medicaid (State)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
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    {
      "description": "Strep a dna dir probe",
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        {
          "code": "87650",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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      "description": "Strep a dna amp probe",
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        {
          "code": "87651",
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        }
      ],
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        {
          "setting": "outpatient",
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          ],
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    {
      "description": "Influenza assay w/optic",
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        {
          "code": "87804",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Hiv ag w/hiv1&2 antb w/optic",
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        {
          "code": "87806",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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            },
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Sars-cov-2 covid19 w/optic",
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        {
          "code": "87811",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Strep a assay w/optic",
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        {
          "code": "87880",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
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          ],
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      ]
    },
    {
      "description": "Cytopath concentrate tech",
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        {
          "code": "88108",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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    },
    {
      "description": "Cytopath cell enhance tech",
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        {
          "code": "88112",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Cytopath smear other source",
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        {
          "code": "88161",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
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    {
      "description": "Cytopath eval fna report",
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        {
          "code": "88173",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Surgical path gross",
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        {
          "code": "88300",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            }
          ],
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        }
      ]
    },
    {
      "description": "Tissue exam by pathologist",
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        {
          "code": "88302",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Tissue exam by pathologist",
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        {
          "code": "88304",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Tissue exam by pathologist",
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        {
          "code": "88305",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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            {
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            },
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              "methodology": "fee schedule"
            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
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    {
      "description": "Tissue exam by pathologist",
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        {
          "code": "88307",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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      ]
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    {
      "description": "Tissue exam by pathologist",
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        {
          "code": "88309",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 414.65,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Decalcify tissue",
      "code_information": [
        {
          "code": "88311",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
            {
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      ]
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    {
      "description": "Special stains group 1",
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        {
          "code": "88312",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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      "description": "Special stains group 2",
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        {
          "code": "88313",
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      ],
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        {
          "setting": "outpatient",
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              "methodology": "fee schedule"
            },
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    },
    {
      "description": "Path consltj drg surg",
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        {
          "code": "88329",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 32.98,
              "methodology": "fee schedule"
            },
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            },
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    },
    {
      "description": "Path consltj surg 1 blk 1spc",
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        {
          "code": "88331",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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    {
      "description": "Imhchem/imcytchm ea add antb",
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        {
          "code": "88341",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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    {
      "description": "Imhchem/imcytchm 1st antb",
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        {
          "code": "88342",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Body fluid cell count",
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        {
          "code": "89050",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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            }
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      ]
    },
    {
      "description": "Body fluid cell count",
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        {
          "code": "89051",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
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              "payer_name": "Coventry Health Care",
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              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Immunization admin",
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        {
          "code": "90471",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
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              "payer_name": "Coventry Health Care",
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            },
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Rabies vaccine im",
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        {
          "code": "90675",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 327.78,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ]
    },
    {
      "description": "Tdap vaccine 7 yrs/> im",
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        {
          "code": "90715",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 38.63,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 38.63,
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            },
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              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ]
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    {
      "description": "Group psychotherapy",
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        {
          "code": "90853",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 24.09,
              "methodology": "fee schedule"
            },
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            },
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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            }
          ],
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    },
    {
      "description": "Hemodialysis one evaluation",
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        {
          "code": "90935",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "estimated_amount": 945,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "estimated_amount": 1147.5,
              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 67.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 67.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 67.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 67.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 64.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 1350,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 1350,
              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Extended visual field xm",
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        {
          "code": "92083",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 60.97,
              "methodology": "fee schedule"
            },
            {
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              "estimated_amount": 60.97,
              "methodology": "fee schedule"
            },
            {
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ]
    },
    {
      "description": "Cmptr ophth img optic nerve",
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        {
          "code": "92133",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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      ]
    },
    {
      "description": "Cptr ophth dx img post segmt",
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        {
          "code": "92134",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 33.3,
              "methodology": "fee schedule"
            },
            {
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              "estimated_amount": 33.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 33.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 33.3,
              "methodology": "fee schedule"
            }
          ],
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          "maximum": 33.3
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      ]
    },
    {
      "description": "Fundus photography w/i&r",
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        {
          "code": "92250",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35.41,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 35.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Speech/hearing therapy",
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        {
          "code": "92507",
          "type": "HCPCS"
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      ],
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          "setting": "outpatient",
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            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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      "description": "Speech sound lang comprehen",
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        {
          "code": "92523",
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          "setting": "outpatient",
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              "payer_name": "Cigna Health and Life Insurance Company",
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      "description": "Oral function therapy",
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          "code": "92526",
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              "payer_name": "Coventry Health Care",
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      "description": "Evaluate swallowing function",
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          "code": "92610",
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          "setting": "outpatient",
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      "description": "Motion fluoroscopy/swallow",
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          "code": "92611",
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    {
      "description": "Aep neurodiagnostic i&r",
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        {
          "code": "92653",
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    {
      "description": "Prq card stent w/angio 1 vsl",
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        {
          "code": "92928",
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    {
      "description": "Prq revasc byp graft 1 vsl",
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        {
          "code": "92937",
          "type": "HCPCS"
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      ],
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        {
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    {
      "description": "Heart/lung resuscitation cpr",
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        {
          "code": "92950",
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    {
      "description": "Cardioversion electric ext",
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        {
          "code": "92960",
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    {
      "description": "Endoluminl ivus oct c 1st",
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        {
          "code": "92978",
          "type": "HCPCS"
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    {
      "description": "Electrocardiogram tracing",
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        {
          "code": "93005",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.06,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 6.06,
          "maximum": 6.06
        }
      ]
    },
    {
      "description": "Cardiovascular stress test",
      "code_information": [
        {
          "code": "93017",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.03,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 37.03,
          "maximum": 37.03
        }
      ]
    },
    {
      "description": "Ecg monit/reprt up to 48 hrs",
      "code_information": [
        {
          "code": "93225",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 17.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 17.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 17.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 17.38,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17.38,
          "maximum": 17.38
        }
      ]
    },
    {
      "description": "Ecg monit/reprt up to 48 hrs",
      "code_information": [
        {
          "code": "93226",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 33.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 33.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 33.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33.23,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 33.23,
          "maximum": 33.23
        }
      ]
    },
    {
      "description": "Tte w/doppler complete",
      "code_information": [
        {
          "code": "93306",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 187.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 187.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 187.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 187.34,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 187.34,
          "maximum": 187.34
        }
      ]
    },
    {
      "description": "Tte f-up or lmtd",
      "code_information": [
        {
          "code": "93308",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 94.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 94.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 94.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 94.11,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 94.11,
          "maximum": 94.11
        }
      ]
    },
    {
      "description": "Echo transesophageal",
      "code_information": [
        {
          "code": "93312",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 224.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 224.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 224.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 224.61,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 224.61,
          "maximum": 224.61
        }
      ]
    },
    {
      "description": "Coronary artery angio s&i",
      "code_information": [
        {
          "code": "93454",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 828.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 828.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 828.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 828.4,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 828.4,
          "maximum": 828.4
        }
      ]
    },
    {
      "description": "L hrt artery/ventricle angio",
      "code_information": [
        {
          "code": "93458",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 953.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 953.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 953.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 953.75,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 953.75,
          "maximum": 953.75
        }
      ]
    },
    {
      "description": "L hrt art/grft angio",
      "code_information": [
        {
          "code": "93459",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 1026.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 1026.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 1026.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 1026.32,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 1026.32,
          "maximum": 1026.32
        }
      ]
    },
    {
      "description": "R&l hrt art/ventricle angio",
      "code_information": [
        {
          "code": "93460",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 1138.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 1138.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 1138.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 1138.51,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 1138.51,
          "maximum": 1138.51
        }
      ]
    },
    {
      "description": "Heart flow reserve measure",
      "code_information": [
        {
          "code": "93571",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 66.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 66.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 66.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 66.14,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 66.14,
          "maximum": 66.14
        }
      ]
    },
    {
      "description": "Heart flow reserve measure",
      "code_information": [
        {
          "code": "93572",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 47.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 47.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 47.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 47.97,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 47.97,
          "maximum": 47.97
        }
      ]
    },
    {
      "description": "Cardiac rehab/monitor",
      "code_information": [
        {
          "code": "93798",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 12.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 12.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 12.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 12.77,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 12.77,
          "maximum": 12.77
        }
      ]
    },
    {
      "description": "Extracranial bilat study",
      "code_information": [
        {
          "code": "93880",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 181.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 181.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 181.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 181.03,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 181.03,
          "maximum": 181.03
        }
      ]
    },
    {
      "description": "Lower extremity study",
      "code_information": [
        {
          "code": "93925",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 228.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 228.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 228.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 228.17,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 228.17,
          "maximum": 228.17
        }
      ]
    },
    {
      "description": "Lower extremity study",
      "code_information": [
        {
          "code": "93926",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 136.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 343.8,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 267.4,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 324.7,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 136.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 136.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 136.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 324.7,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 136.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 343.8,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 136.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 204.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 780.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 780.92,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 136.88,
          "maximum": 780.92
        }
      ]
    },
    {
      "description": "Upper extremity study",
      "code_information": [
        {
          "code": "93930",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 189.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
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              "estimated_amount": 189.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 189.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 189.92,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 189.92,
          "maximum": 189.92
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      ]
    },
    {
      "description": "Extremity study",
      "code_information": [
        {
          "code": "93970",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 178.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 920.23,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 715.74,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 869.11,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 178.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 178.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 178.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 869.11,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 178.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 920.23,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 178.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 260.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 1022.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 1022.48,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 178.2,
          "maximum": 1022.48
        }
      ]
    },
    {
      "description": "Extremity study",
      "code_information": [
        {
          "code": "93971",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 114.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 613.84,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 477.43,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 579.73,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 114.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 114.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 114.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 579.73,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 114.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 613.84,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 114.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 170.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 682.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 682.04,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 114.08,
          "maximum": 682.04
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      ]
    },
    {
      "description": "Dup-scan hemo compl bi std",
      "code_information": [
        {
          "code": "93985",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 237.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 237.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 237.28,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 237.28,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 237.28,
          "maximum": 237.28
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      ]
    },
    {
      "description": "Doppler flow testing",
      "code_information": [
        {
          "code": "93990",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 139.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 139.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 139.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 139.54,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 139.54,
          "maximum": 139.54
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      ]
    },
    {
      "description": "Vent mgmt inpat init day",
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        {
          "code": "94002",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 86.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
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              "estimated_amount": 140.49,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
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              "estimated_amount": 109.27,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 132.69,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 86.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 86.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 86.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 132.69,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 86.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 140.49,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 86.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 87.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 356.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 356.32,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 86.63,
          "maximum": 356.32
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      ]
    },
    {
      "description": "Vent mgmt inpat subq day",
      "code_information": [
        {
          "code": "94003",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 60.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 232.7,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 180.99,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 219.78,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 60.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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              "estimated_amount": 60.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 60.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 219.78,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 60.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 60.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 63.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 258.56,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 258.56,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 60.77,
          "maximum": 258.56
        }
      ]
    },
    {
      "description": "Evaluation of wheezing",
      "code_information": [
        {
          "code": "94060",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 37.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 37.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 37.68,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 37.68,
          "maximum": 37.68
        }
      ]
    },
    {
      "description": "Airway inhalation treatment",
      "code_information": [
        {
          "code": "94640",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 7.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 7.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 7.68,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 7.68,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 7.68,
          "maximum": 7.68
        }
      ]
    },
    {
      "description": "Pos airway pressure cpap",
      "code_information": [
        {
          "code": "94660",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 34.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 34.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 34.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 34.84,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34.84,
          "maximum": 34.84
        }
      ]
    },
    {
      "description": "Measure blood oxygen level",
      "code_information": [
        {
          "code": "94760",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 3.47,
          "maximum": 3.47
        }
      ]
    },
    {
      "description": "Measure blood oxygen level",
      "code_information": [
        {
          "code": "94761",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 3.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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    },
    {
      "description": "Eeg awake and drowsy",
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        {
          "code": "95816",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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            },
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      "description": "Eeg awake and asleep",
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        {
          "code": "95819",
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        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
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    {
      "description": "Musc test done w/n test comp",
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        {
          "code": "95886",
          "type": "HCPCS"
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      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Nrv cndj test 13/> studies",
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        {
          "code": "95913",
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Hydration iv infusion init",
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        {
          "code": "96360",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    },
    {
      "description": "Hydrate iv infusion add-on",
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        {
          "code": "96361",
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        }
      ],
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        {
          "setting": "outpatient",
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            {
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      "description": "Ther/proph/diag iv inf init",
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        {
          "code": "96365",
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        }
      ],
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        {
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      "description": "Ther/proph/diag iv inf addon",
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        {
          "code": "96366",
          "type": "HCPCS"
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      ],
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        {
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            {
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    {
      "description": "Tx/proph/dg addl seq iv inf",
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        {
          "code": "96367",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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    {
      "description": "Ther/diag concurrent inf",
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        {
          "code": "96368",
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        }
      ],
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        {
          "setting": "outpatient",
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            {
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    {
      "description": "Ther/proph/diag inj sc/im",
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        {
          "code": "96372",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    },
    {
      "description": "Ther/proph/diag inj iv push",
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        {
          "code": "96374",
          "type": "HCPCS"
        }
      ],
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        {
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
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            },
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Tx/pro/dx inj new drug addon",
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        {
          "code": "96375",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
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            {
              "payer_name": "Coventry Health Care",
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ]
    },
    {
      "description": "Therapeutic exercises",
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        {
          "code": "97110",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "payer_name": "Cofinity",
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            },
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              "payer_name": "Medicare (CMS)",
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            },
            {
              "payer_name": "Medicaid (State)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 65,
              "methodology": "fee schedule"
            }
          ],
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          "maximum": 120
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      ]
    },
    {
      "description": "Neuromuscular reeducation",
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        {
          "code": "97112",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
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            },
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              "payer_name": "Wise Provider Networks",
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            },
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              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 31.94,
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            },
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              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            },
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              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 29.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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      "description": "Gait training therapy",
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        {
          "code": "97116",
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      ],
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              "payer_name": "Cigna Health and Life Insurance Company",
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      "description": "Pt eval low complex 20 min",
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        {
          "code": "97161",
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      "description": "Pt eval high complex 45 min",
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      "description": "Pt re-eval est plan care",
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        }
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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    {
      "description": "Ot eval low complex 30 min",
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            },
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 100.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 100.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 221,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 100.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 234,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 100.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 69.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 69.72,
          "maximum": 260
        }
      ]
    },
    {
      "description": "Therapeutic activities",
      "code_information": [
        {
          "code": "97530",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 34.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 58.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 45.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 55.25,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Workers' Compensation Program",
              "standard_charge_dollar": 120,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 34.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 34.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
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              "estimated_amount": 34.53,
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            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "estimated_amount": 34.53,
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            },
            {
              "payer_name": "Cofinity",
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              "standard_charge_percentage": 90,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 34.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 29.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 65,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29.83,
          "maximum": 120
        }
      ]
    },
    {
      "description": "Self care mngment training",
      "code_information": [
        {
          "code": "97535",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 70,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Workers' Compensation Program",
              "standard_charge_dollar": 120,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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              "estimated_amount": 31.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
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              "estimated_amount": 31.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 31.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 31.94,
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            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 30.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 100,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 100,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30.19,
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      ]
    },
    {
      "description": "Mod sed same phys/qhp 5/>yrs",
      "code_information": [
        {
          "code": "99152",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 11.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 11.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 11.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 11.39,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 11.39,
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        }
      ]
    },
    {
      "description": "Mod sed same phys/qhp ea",
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        {
          "code": "99153",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 11.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 11.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 11.48,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Mod sed other phys/qhp ea",
      "code_information": [
        {
          "code": "99157",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 54.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 54.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 54.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 54.21,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 54.21,
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        }
      ]
    },
    {
      "description": "Emr dpt vst mayx req phy/qhp",
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        {
          "code": "99281",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 10.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 10.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 10.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "estimated_amount": 10.74,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 10.74,
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      ]
    },
    {
      "description": "Emergency dept visit sf mdm",
      "code_information": [
        {
          "code": "99282",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 39.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 39.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 39.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 39.59,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39.59,
          "maximum": 39.59
        }
      ]
    },
    {
      "description": "Emergency dept visit low mdm",
      "code_information": [
        {
          "code": "99283",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 66.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 66.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 66.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 66.9,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 66.9,
          "maximum": 66.9
        }
      ]
    },
    {
      "description": "Emergency dept visit mod mdm",
      "code_information": [
        {
          "code": "99284",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 114,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 114,
          "maximum": 114
        }
      ]
    },
    {
      "description": "Emergency dept visit hi mdm",
      "code_information": [
        {
          "code": "99285",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 165.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 165.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 165.22,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 165.22,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 165.22,
          "maximum": 165.22
        }
      ]
    },
    {
      "description": "Critical care first hour",
      "code_information": [
        {
          "code": "99291",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 202.01,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 202.01,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 202.01,
          "maximum": 202.01
        }
      ]
    },
    {
      "description": "Sterile water/saline, 10 ml",
      "code_information": [
        {
          "code": "A4216",
          "type": "HCPCS"
        },
        {
          "code": "00019-1188-75",
          "type": "NDC"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 0.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 0.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 0.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 0.62,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 0.62,
          "maximum": 0.62
        }
      ],
      "drug_information": {
        "unit": "50",
        "type": "ML"
      }
    },
    {
      "description": "Sterile water/saline, 500 ml",
      "code_information": [
        {
          "code": "A4217",
          "type": "HCPCS"
        },
        {
          "code": "00019-1188-27",
          "type": "NDC"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 4.38,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 4.38,
          "maximum": 4.38
        }
      ],
      "drug_information": {
        "unit": "125",
        "type": "ML"
      }
    },
    {
      "description": "Fem urinary collect pouch",
      "code_information": [
        {
          "code": "A4328",
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        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Bedside drainage bag",
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        {
          "code": "A4357",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Clsd ostomy pouch w/flange",
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        {
          "code": "A5054",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 2.51,
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            },
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    {
      "description": "Foam drg <=16 sq in w/border",
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        {
          "code": "A6212",
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      ],
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        {
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              "payer_name": "United Healthcare (UHC)",
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    {
      "description": "Sterile gauze>16 <= 48 sq in",
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        {
          "code": "A6403",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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    },
    {
      "description": "Gad-base mr contrast nos,1ml",
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        {
          "code": "A9579",
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
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      "description": "Drug test def 1-7 classes",
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        {
          "code": "G0480",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
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    {
      "description": "Inj, acetaminophen (nos)",
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        {
          "code": "J0131",
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        {
          "code": "36000-0372-40",
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
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            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Adrenalin epinephrine inject",
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        {
          "code": "J0171",
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        {
          "code": "00093-5985-27",
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      ],
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        {
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            },
            {
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    },
    {
      "description": "Ampicillin 500 mg inj",
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        {
          "code": "J0290",
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        {
          "code": "00409-3718-01",
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        }
      ],
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        {
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    },
    {
      "description": "Ampicillin sulbactam 1.5 gm",
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        {
          "code": "J0295",
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        {
          "code": "00049-0013-83",
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        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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            },
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    },
    {
      "description": "Hydralazine hcl injection",
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        {
          "code": "J0360",
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        {
          "code": "00641-6231-25",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
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            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ],
      "drug_information": {
        "unit": "1",
        "type": "ML"
      }
    },
    {
      "description": "Azithromycin",
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        {
          "code": "J0456",
          "type": "HCPCS"
        },
        {
          "code": "00069-3150-83",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 2.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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      ],
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        "unit": "1",
        "type": "EA"
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    },
    {
      "description": "Atropine sulfate injection",
      "code_information": [
        {
          "code": "J0461",
          "type": "HCPCS"
        },
        {
          "code": "16729-0512-43",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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            },
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            },
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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        "unit": "20",
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    },
    {
      "description": "Dicyclomine injection",
      "code_information": [
        {
          "code": "J0500",
          "type": "HCPCS"
        },
        {
          "code": "00517-1980-05",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
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              "payer_name": "United Healthcare (UHC)",
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            },
            {
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    },
    {
      "description": "Bivalirudin",
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        {
          "code": "J0583",
          "type": "HCPCS"
        },
        {
          "code": "00338-9572-24",
          "type": "NDC"
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      ],
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        {
          "setting": "outpatient",
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            },
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            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
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    },
    {
      "description": "Calcium glucon (fresenius)",
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        {
          "code": "J0612",
          "type": "HCPCS"
        },
        {
          "code": "00143-9180-25",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
            },
            {
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              "estimated_amount": 0.04,
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            },
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              "estimated_amount": 0.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            }
          ],
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      "drug_information": {
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    },
    {
      "description": "Inj, bupivacaine, nos, 0.5mg",
      "code_information": [
        {
          "code": "J0665",
          "type": "HCPCS"
        },
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        {
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        {
          "code": "00264-1940-20",
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      ],
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        {
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    },
    {
      "description": "Normal saline solution infus",
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        {
          "code": "J7030",
          "type": "HCPCS"
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        {
          "code": "00264-7800-00",
          "type": "NDC"
        }
      ],
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        {
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    },
    {
      "description": "Normal saline solution infus",
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        {
          "code": "J7040",
          "type": "HCPCS"
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        {
          "code": "00264-5802-00",
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      ],
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        {
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "Coventry Health Care",
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            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    },
    {
      "description": "5% dextrose/normal saline",
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        {
          "code": "J7042",
          "type": "HCPCS"
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        {
          "code": "00264-7610-00",
          "type": "NDC"
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      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            {
              "payer_name": "Coventry Health Care",
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            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "methodology": "fee schedule"
            }
          ],
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      ],
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        "unit": "1000",
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    },
    {
      "description": "Normal saline solution infus",
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        {
          "code": "J7050",
          "type": "HCPCS"
        },
        {
          "code": "00264-1800-32",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ],
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    },
    {
      "description": "5% dextrose/water",
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        {
          "code": "J7060",
          "type": "HCPCS"
        },
        {
          "code": "00264-1510-31",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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          ],
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      ],
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        "unit": "50",
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    },
    {
      "description": "Ringers lactate infusion",
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        {
          "code": "J7120",
          "type": "HCPCS"
        },
        {
          "code": "00264-7750-00",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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      ],
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        "unit": "1000",
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    },
    {
      "description": "Tacrolimus imme rel oral 1mg",
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        {
          "code": "J7507",
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        {
          "code": "00378-2045-01",
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        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ],
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    },
    {
      "description": "Prednisolone oral per 5 mg",
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        {
          "code": "J7510",
          "type": "HCPCS"
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        {
          "code": "00093-6118-87",
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        }
      ],
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        {
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              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    },
    {
      "description": "Prednisone ir or dr oral 1mg",
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        {
          "code": "J7512",
          "type": "HCPCS"
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        {
          "code": "00054-0017-20",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
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            {
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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          ],
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        "type": "EA"
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    },
    {
      "description": "Mycophenolate mofetil oral",
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        {
          "code": "J7517",
          "type": "HCPCS"
        },
        {
          "code": "00004-0259-01",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
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              "estimated_amount": 0.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 0.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "methodology": "fee schedule"
            }
          ],
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      ],
      "drug_information": {
        "unit": "100",
        "type": "EA"
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    },
    {
      "description": "Oral dexamethasone",
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        {
          "code": "J8540",
          "type": "HCPCS"
        },
        {
          "code": "00054-3176-44",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "methodology": "fee schedule"
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          ],
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    },
    {
      "description": "Bevacizumab injection",
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        {
          "code": "J9035",
          "type": "HCPCS"
        },
        {
          "code": "50242-0060-01",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
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            {
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "methodology": "fee schedule"
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          ],
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      ],
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    },
    {
      "description": "Mitomycin injection",
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        {
          "code": "J9280",
          "type": "HCPCS"
        },
        {
          "code": "00143-9135-01",
          "type": "NDC"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
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            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
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          ],
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      ],
      "drug_information": {
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    },
    {
      "description": "Lumbar orthosis, flexible, provides lumbar support, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf",
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        {
          "code": "L0625",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
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              "methodology": "fee schedule"
            },
            {
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              "standard_charge_percentage": 100,
              "estimated_amount": 27.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies",
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        {
          "code": "L8603",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 525.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 525.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
            }
          ],
          "minimum": 525.58,
          "maximum": 525.58
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      ]
    },
    {
      "description": "Ocular implant",
      "code_information": [
        {
          "code": "L8610",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage Benefit Plans",
              "standard_charge_percentage": 100,
              "estimated_amount": 936.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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      "description": "Albumin (human), 25%, 20 ml",
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          "code": "P9046",
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      "description": "Locm 300-399mg/ml iodine,1ml",
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        {
          "code": "Q9967",
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      "description": "Anter chamber intraocul lens",
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          "code": "V2630",
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      "description": "Post chmbr intraocular lens",
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          "code": "V2632",
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      "description": "Room & Board - Private (One Bed) - Rehabilitation",
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          "code": "0118",
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            },
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              "payer_name": "First Choice of the Midwest",
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              "payer_name": "Wise Provider Networks",
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              "payer_name": "Cigna Health and Life Insurance Company",
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              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "Coventry Health Care",
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              "payer_name": "Coventry Health Care",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
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              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
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              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
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      "description": "Room & Board - Semi-private (Two Beds) - Rehabilitation",
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          "code": "0128",
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            },
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              "payer_name": "Humana Insurance Company",
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            },
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
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              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
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              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
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              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
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              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
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      "description": "Room & Board - Three and Four Beds - Rehabilitation",
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          "code": "0138",
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            },
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            },
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            },
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            },
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              "payer_name": "Humana Insurance Company",
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            },
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      "description": "Room & Board - Deluxe Private - Rehabilitation",
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              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
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            },
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              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
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      "description": "Room & Board - Ward - Rehabilitation",
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          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "PPO",
              "standard_charge_dollar": 1150,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Indemnity ",
              "standard_charge_dollar": 1150,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "HMO",
              "standard_charge_dollar": 1150,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Commercial",
              "standard_charge_dollar": 1275,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Individul Exchange (ACA)",
              "standard_charge_dollar": 1275,
              "methodology": "per diem"
            },
            {
              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
              "plan_name": "Workers' Compensation",
              "standard_charge_dollar": 2450,
              "methodology": "per diem"
            },
            {
              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
              "plan_name": "Other Long-term Care Products",
              "standard_charge_dollar": 2450,
              "methodology": "per diem"
            },
            {
              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
              "plan_name": "No Fault",
              "standard_charge_dollar": 2450,
              "methodology": "per diem"
            },
            {
              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
              "plan_name": "Liability",
              "standard_charge_dollar": 2450,
              "methodology": "per diem"
            },
            {
              "payer_name": "Paradigm Specialty Networks fka AdvaNet",
              "plan_name": "Auto Liability",
              "standard_charge_dollar": 2450,
              "methodology": "per diem"
            }
          ],
          "minimum": 1150,
          "maximum": 2450
        }
      ]
    },
    {
      "description": "Ndl insj w/o njx 3+ musc",
      "code_information": [
        {
          "code": "20561",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Commercial",
              "standard_charge_percentage": 85,
              "estimated_amount": 110.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 117,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 91,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 110.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 21.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 110.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 117,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 130,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 130,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21.74,
          "maximum": 130
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      ]
    },
    {
      "description": "Ndl insj w/o njx 1 or 2 musc",
      "code_information": [
        {
          "code": "20560",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Commercial",
              "standard_charge_percentage": 85,
              "estimated_amount": 110.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 117,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 91,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 110.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 110.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 117,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 130,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 130,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 14.39,
          "maximum": 130
        }
      ]
    },
    {
      "description": "Ct head/brain w/o & w/dye",
      "code_information": [
        {
          "code": "70470",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Commercial",
              "standard_charge_percentage": 85,
              "estimated_amount": 1158.14,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 1226.27,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 953.76,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 1158.14,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 170.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 1158.14,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 1226.27,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 170.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 240.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 1362.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 1362.52,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 170.11,
          "maximum": 1362.52
        }
      ]
    },
    {
      "description": "Application of finger splint",
      "code_information": [
        {
          "code": "29130",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Commercial",
              "standard_charge_percentage": 85,
              "estimated_amount": 110.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 117,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 91,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 110.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 110.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 117,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 35.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 130,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 130,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27.47,
          "maximum": 130
        }
      ]
    },
    {
      "description": "Mri lumbar spine w/o & w/dye",
      "code_information": [
        {
          "code": "72158",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Commercial",
              "standard_charge_percentage": 85,
              "estimated_amount": 2427.29,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 2570.08,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 1998.95,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 2427.29,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 313.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 2427.29,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 2570.08,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 313.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 572.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 2855.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 2855.64,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 313.06,
          "maximum": 2855.64
        }
      ]
    },
    {
      "description": "Debride nail 6 or more",
      "code_information": [
        {
          "code": "11721",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 40.97,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22.63,
          "maximum": 40.97
        }
      ]
    },
    {
      "description": "Apply forearm splint",
      "code_information": [
        {
          "code": "29126",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Commercial",
              "standard_charge_percentage": 85,
              "estimated_amount": 148.75,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
              "standard_charge_percentage": 90,
              "estimated_amount": 157.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
              "plan_name": "PPO",
              "standard_charge_percentage": 70,
              "estimated_amount": 122.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 148.75,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 148.75,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 157.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 65.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 195,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 195,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 48,
          "maximum": 195
        }
      ]
    },
    {
      "description": "All Inclusive Rate - Room and Board Plus Ancillary",
      "code_information": [
        {
          "code": "0100",
          "type": "RC"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "PPO",
              "standard_charge_dollar": 1460,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Indemnity ",
              "standard_charge_dollar": 1460,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "HMO",
              "standard_charge_dollar": 1460,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Commercial",
              "standard_charge_dollar": 1275,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Individul Exchange (ACA)",
              "standard_charge_dollar": 1275,
              "methodology": "per diem"
            }
          ],
          "minimum": 1275,
          "maximum": 1460
        }
      ]
    },
    {
      "description": "All Inclusive Rate - Room and Board",
      "code_information": [
        {
          "code": "0101",
          "type": "RC"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "PPO",
              "standard_charge_dollar": 1460,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Indemnity ",
              "standard_charge_dollar": 1460,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "HMO",
              "standard_charge_dollar": 1460,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Commercial",
              "standard_charge_dollar": 1275,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Individul Exchange (ACA)",
              "standard_charge_dollar": 1275,
              "methodology": "per diem"
            }
          ],
          "minimum": 1275,
          "maximum": 1460
        }
      ]
    },
    {
      "description": "Room & Board - Private (One Bed) - General Classification",
      "code_information": [
        {
          "code": "0110",
          "type": "RC"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "PPO",
              "standard_charge_dollar": 1460,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Indemnity ",
              "standard_charge_dollar": 1460,
              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "HMO",
              "standard_charge_dollar": 1460,
              "methodology": "per diem"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Advantage Networks",
              "standard_charge_dollar": 1000,
              "methodology": "per diem"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "National POS (NPOS)",
              "standard_charge_dollar": 1000,
              "methodology": "per diem"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HMO Premier",
              "standard_charge_dollar": 1000,
              "methodology": "per diem"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HMO Select",
              "standard_charge_dollar": 1000,
              "methodology": "per diem"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Network",
              "standard_charge_dollar": 1000,
              "methodology": "per diem"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Automobile Insurance Compensation Program",
              "standard_charge_dollar": 1050,
              "methodology": "per diem"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Workers' Compensation Program",
              "standard_charge_dollar": 1050,
              "methodology": "per diem"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Network Lease",
              "standard_charge_dollar": 1050,
              "methodology": "per diem"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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            }
          ],
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        }
      ]
    },
    {
      "description": "Room & Board - Private (One Bed) - Medical/Surgical/GYN",
      "code_information": [
        {
          "code": "0111",
          "type": "RC"
        }
      ],
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        {
          "setting": "inpatient",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
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            }
          ],
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      ]
    },
    {
      "description": "Room & Board - Private (One Bed) - Obstetrics (OB)",
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        {
          "code": "0112",
          "type": "RC"
        }
      ],
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        {
          "setting": "inpatient",
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            {
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            },
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              "payer_name": "United Healthcare (UHC)",
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            },
            {
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            },
            {
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            },
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          ],
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      "description": "Room & Board - Private (One Bed) - Pediatric",
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        {
          "code": "0113",
          "type": "RC"
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      ],
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        {
          "setting": "inpatient",
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            },
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            },
            {
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            {
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        {
          "code": "0119",
          "type": "RC"
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      ],
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        {
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            },
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            },
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            },
            {
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            }
          ],
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      ]
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    {
      "description": "Room & Board - Semi-private (Two Beds) - General Classification",
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        {
          "code": "0120",
          "type": "RC"
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      ],
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        {
          "setting": "inpatient",
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            {
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            },
            {
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
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            }
          ],
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      ]
    },
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        {
          "code": "0121",
          "type": "RC"
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      ],
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        {
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            {
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            },
            {
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            },
            {
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            },
            {
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            },
            {
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            }
          ],
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      ]
    },
    {
      "description": "Room & Board - Semi-private (Two Beds) - Obstetrics (OB)",
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        {
          "code": "0122",
          "type": "RC"
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      ],
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        {
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            },
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            },
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            },
            {
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            },
            {
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            }
          ],
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      ]
    },
    {
      "description": "Room & Board - Semi-private (Two Beds) - Pediatric",
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        {
          "code": "0123",
          "type": "RC"
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      ],
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        {
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            },
            {
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            },
            {
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            },
            {
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            },
            {
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            }
          ],
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      ]
    },
    {
      "description": "Room & Board - Semi-private (Two Beds) - Other",
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        {
          "code": "0129",
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      ],
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        {
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            {
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            },
            {
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            },
            {
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            },
            {
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            }
          ],
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      ]
    },
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      "description": "Room & Board - Three and Four Beds - General Classification",
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        {
          "code": "0130",
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      ],
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        {
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            },
            {
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            },
            {
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            },
            {
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            },
            {
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            }
          ],
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        }
      ]
    },
    {
      "description": "Room & Board - Three and Four Beds - Medical/Surgical/GYN",
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        {
          "code": "0131",
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      ],
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        {
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            },
            {
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
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            }
          ],
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      ]
    },
    {
      "description": "Room & Board - Three and Four Beds - Obstetrics (OB)",
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        {
          "code": "0132",
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      ],
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        {
          "setting": "inpatient",
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            },
            {
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
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            }
          ],
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      ]
    },
    {
      "description": "Room & Board - Three and Four Beds - Pediatric",
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        {
          "code": "0133",
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      ],
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        {
          "setting": "inpatient",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            }
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    {
      "description": "Room & Board - Three and Four Beds - Other",
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        {
          "code": "0139",
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      ],
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        {
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            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
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            }
          ],
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      ]
    },
    {
      "description": "Room & Board - Deluxe Private - General Classification",
      "code_information": [
        {
          "code": "0140",
          "type": "RC"
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      ],
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        {
          "setting": "inpatient",
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            },
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            },
            {
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            },
            {
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            }
          ],
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      ]
    },
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      "description": "Room & Board - Deluxe Private - Medical/Surgical/GYN",
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        {
          "code": "0141",
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      ],
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        {
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            },
            {
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            }
          ],
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        }
      ]
    },
    {
      "description": "Room & Board - Deluxe Private - Obstetrics (OB)",
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        {
          "code": "0142",
          "type": "RC"
        }
      ],
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        {
          "setting": "inpatient",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            }
          ],
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          "maximum": 1460
        }
      ]
    },
    {
      "description": "Room & Board - Deluxe Private - Pediatric",
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        {
          "code": "0143",
          "type": "RC"
        }
      ],
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        {
          "setting": "inpatient",
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            },
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            },
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              "payer_name": "United Healthcare (UHC)",
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              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "per diem"
            }
          ],
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      ]
    },
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      "description": "Room & Board - Deluxe Private - Other",
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        {
          "code": "0149",
          "type": "RC"
        }
      ],
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        {
          "setting": "inpatient",
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              "payer_name": "United Healthcare (UHC)",
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              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "per diem"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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            },
            {
              "payer_name": "United Healthcare (UHC)",
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            {
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      "description": "Room & Board - Ward - General Classification",
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        {
          "code": "0150",
          "type": "RC"
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      ],
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        {
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            },
            {
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            {
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        {
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            {
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          ],
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      ]
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    {
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          "type": "RC"
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      ],
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        {
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            {
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            {
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            {
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            {
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          ],
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    {
      "description": "Room & Board - Ward - Pediatrics",
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      ],
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        {
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            {
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            },
            {
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            {
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            {
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          ],
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    },
    {
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      ],
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        {
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            },
            {
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            },
            {
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            },
            {
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            },
            {
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          ],
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      ],
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        {
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            {
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            },
            {
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            },
            {
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            }
          ],
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      "description": "Nursery - General Classification",
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      ],
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        {
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            {
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            {
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            {
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          ],
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    {
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      ],
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            {
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          ],
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      ],
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          ],
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      ],
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            {
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      ],
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          ],
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    {
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        {
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      ],
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        {
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            {
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          ],
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    {
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      ],
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            {
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            {
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      ],
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            },
            {
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            {
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    {
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      ],
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            {
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    {
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      ],
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            {
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          ],
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    {
      "description": "Intensive Care Unit - Burn Care",
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      ],
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            }
          ],
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    {
      "description": "Intensive Care Unit - Trauma",
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      ],
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              "standard_charge_percentage": 70,
              "estimated_amount": 182,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 221,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 100.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
              "estimated_amount": 221,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
              "plan_name": "PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 234,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 100.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
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          ],
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      ]
    },
    {
      "description": "Wheelchair mngment training",
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        {
          "code": "97542",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
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              "methodology": "percent of total billed charges"
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "estimated_amount": 55.25,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 30.64,
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            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 30.64,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 26.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 65,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
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          ],
          "minimum": 26.96,
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      ]
    },
    {
      "description": "Endoscopy swallow (fees) vid",
      "code_information": [
        {
          "code": "92612",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 86.7,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
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              "payer_name": "Medicare (CMS)",
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            },
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              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 152.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
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          ],
          "minimum": 63.62,
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      ]
    },
    {
      "description": "Orthotic mgmt&traing 1st enc",
      "code_information": [
        {
          "code": "97760",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "First Choice of the Midwest",
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              "payer_name": "Wise Provider Networks",
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            },
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              "payer_name": "Cigna Health and Life Insurance Company",
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
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              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
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            },
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              "payer_name": "Medicaid (State)",
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              "estimated_amount": 32.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
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            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Ot re-eval est plan care",
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        {
          "code": "97168",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
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              "estimated_amount": 221,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_dollar": 120,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 69.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
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            {
              "payer_name": "Cofinity",
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              "estimated_amount": 234,
              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 69.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 260,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 46,
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        }
      ]
    },
    {
      "description": "Electric stimulation therapy",
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        {
          "code": "97014",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Cigna Health and Life Insurance Company",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
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              "payer_name": "InterWest Health",
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            },
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              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Medicare (CMS)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 65,
              "methodology": "fee schedule"
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            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            }
          ],
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      ]
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    {
      "description": "Orthc/prostc mgmt sbsq enc",
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        {
          "code": "97763",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "First Choice of the Midwest",
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            },
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              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 50.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 50.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 42.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 81.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 81.24,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 42.77,
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      ]
    },
    {
      "description": "Canalith repositioning proc",
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        {
          "code": "95992",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "First Choice of the Midwest",
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              "estimated_amount": 117,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 110.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 34.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
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              "estimated_amount": 110.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
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              "standard_charge_percentage": 90,
              "estimated_amount": 117,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 34.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 38.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 130,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 130,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 34.03,
          "maximum": 130
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      ]
    },
    {
      "description": "Sensory integration",
      "code_information": [
        {
          "code": "97533",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 55.25,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Workers' Compensation Program",
              "standard_charge_dollar": 120,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 60.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
              "plan_name": "PPO",
              "standard_charge_percentage": 85,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 60.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
              "plan_name": "Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 25.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 123,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 123,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25.88,
          "maximum": 123
        }
      ]
    },
    {
      "description": "Community/work reintegration",
      "code_information": [
        {
          "code": "97537",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "First Choice of the Midwest",
              "plan_name": "PPO Network",
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              "estimated_amount": 58.5,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "standard_charge_percentage": 70,
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "GWH-CIGNA Network",
              "standard_charge_percentage": 85,
              "estimated_amount": 55.25,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Workers' Compensation Program",
              "standard_charge_dollar": 120,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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      "description": "Caregiver traing 1st 30 min",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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      "description": "Sbsq hosp ip/obs sf/low 25",
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      "description": "C diff amplified probe",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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      "description": "Manual therapy 1/> regions",
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        {
          "code": "97140",
          "type": "HCPCS"
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        {
          "setting": "outpatient",
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            {
              "payer_name": "First Choice of the Midwest",
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              "payer_name": "Wise Provider Networks",
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              "payer_name": "Cigna Health and Life Insurance Company",
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            },
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              "payer_name": "Coventry Health Care",
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "payer_name": "InterWest Health",
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              "payer_name": "Medicaid (State)",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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      ]
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    {
      "description": "Ther ivntj ea addl 15 min",
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        {
          "code": "97130",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "First Choice of the Midwest",
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            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "payer_name": "InterWest Health",
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              "payer_name": "Cofinity",
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              "payer_name": "Medicare (CMS)",
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            },
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              "payer_name": "Medicaid (State)",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 114,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
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    {
      "description": "Aquatic therapy/exercises",
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        {
          "code": "97113",
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        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "First Choice of the Midwest",
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              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
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              "payer_name": "Medicare (CMS)",
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              "payer_name": "Medicaid (State)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
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          ],
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      ]
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    {
      "description": "Ther ivntj 1st 15 min",
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        {
          "code": "97129",
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        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "First Choice of the Midwest",
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              "payer_name": "Wise Provider Networks",
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            },
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              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "payer_name": "InterWest Health",
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              "payer_name": "Medicaid (State)",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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    {
      "description": "Cognitive test by hc pro",
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        {
          "code": "96125",
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          "setting": "outpatient",
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            {
              "payer_name": "First Choice of the Midwest",
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            },
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              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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            },
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              "payer_name": "Medicaid (State)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
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      ]
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    {
      "description": "Appl modality 1+estim ea 15",
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        {
          "code": "97032",
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        }
      ],
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          "setting": "outpatient",
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              "payer_name": "First Choice of the Midwest",
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              "payer_name": "Cigna Health and Life Insurance Company",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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            },
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              "payer_name": "Medicaid (State)",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 111,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
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              "methodology": "fee schedule"
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          ],
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    {
      "description": "Ot eval high complex 60 min",
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        {
          "code": "97167",
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        }
      ],
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          "setting": "outpatient",
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            {
              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
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              "payer_name": "Wise Provider Networks",
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            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
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              "payer_name": "Medicare (CMS)",
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            },
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              "payer_name": "Medicaid (State)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 260,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            }
          ],
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    {
      "description": "Behavral qualit analys voice",
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        {
          "code": "92524",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
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            },
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              "payer_name": "Medicaid (State)",
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              "estimated_amount": 82.62,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 359,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            }
          ],
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      ]
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    {
      "description": "App mdlty 1+ultrasound ea 15",
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        {
          "code": "97035",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "First Choice of the Midwest",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Wise Provider Networks",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "InterWest Health",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cofinity",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Medicare (CMS)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicaid (State)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 11.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 106,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 106,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 11.5,
          "maximum": 106
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      ]
    },
    {
      "description": "Massage therapy",
      "code_information": [
        {
          "code": "97124",
          "type": "HCPCS"
        }
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      "description": "Glucose blood test",
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        {
          "code": "82962",
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      "description": "Assessment of aphasia",
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          "code": "96105",
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          "code": "97750",
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      "description": "1st hosp ip/obs high 75",
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        {
          "code": "99223",
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      "description": "Inj ivig privigen 500 mg",
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          "code": "J1459",
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        {
          "code": "44206-0436-05",
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      "description": "Gamunex-c/gammaked",
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          "code": "J1561",
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      "description": "Octagam injection",
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        {
          "code": "J1568",
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        {
          "code": "00069-6002-02",
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      "description": "Stroke M >=72.50- Tier Tier 1",
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          "code": "B0101",
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      "description": "Stroke M >=72.50- Tier Tier 2",
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          "code": "C0101",
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Stroke M >=72.50- Tier Tier 3",
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        {
          "code": "D0101",
          "type": "LOCAL"
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        {
          "setting": "inpatient",
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              "payer_name": "Humana Insurance Company",
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      "description": "Stroke M >=63.50 and M <72.50- Tier Tier 1",
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          "code": "B0102",
          "type": "LOCAL"
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          "setting": "inpatient",
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            },
            {
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            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 23737.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23737.51,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23737.51,
              "methodology": "fee schedule"
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          "minimum": 23262.76,
          "maximum": 23737.51
        }
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    {
      "description": "Stroke M >=63.50 and M <72.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0102",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 20657.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
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              "estimated_amount": 20657.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
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              "estimated_amount": 20657.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 20657.84,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 21079.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 21079.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 21079.43,
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 21079.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 21079.43,
              "methodology": "fee schedule"
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          "maximum": 21079.43
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    {
      "description": "Stroke M >=63.50 and M <72.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0102",
          "type": "LOCAL"
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 18716.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 18716.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 18716.44,
              "methodology": "fee schedule"
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 18716.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 19098.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 19098.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 19098.41,
              "methodology": "fee schedule"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 19098.41,
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            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 19098.41,
              "methodology": "fee schedule"
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          "maximum": 19098.41
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    {
      "description": "Stroke M >=50.50 and M <63.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0103",
          "type": "LOCAL"
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 29863.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 29863.89,
              "methodology": "fee schedule"
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 29863.89,
              "methodology": "fee schedule"
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            {
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              "estimated_amount": 29863.89,
              "methodology": "fee schedule"
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            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 30473.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 30473.36,
              "methodology": "fee schedule"
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            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 30473.36,
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 30473.36,
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            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 30473.36,
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    {
      "description": "Stroke M >=50.50 and M <63.50- Tier Tier 2",
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        {
          "code": "C0103",
          "type": "LOCAL"
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 26519.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 26519.85,
              "methodology": "fee schedule"
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 26519.85,
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            {
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              "estimated_amount": 26519.85,
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 27061.07,
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            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 27061.07,
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            {
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              "estimated_amount": 27061.07,
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 27061.07,
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    {
      "description": "Stroke M >=50.50 and M <63.50- Tier Tier 3",
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        {
          "code": "D0103",
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 24026.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 24026.46,
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 24026.46,
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 24026.46,
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 24516.8,
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            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24516.8,
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            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 24516.8,
              "methodology": "fee schedule"
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 24516.8,
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            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 24516.8,
              "methodology": "fee schedule"
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    {
      "description": "Stroke M >=41.50 and M <50.50- Tier Tier 1",
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        {
          "code": "B0104",
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 38141.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 38141.78,
              "methodology": "fee schedule"
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 38141.78,
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 38141.78,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 38920.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 38920.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 38920.18,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 38920.18,
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 38920.18,
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    {
      "description": "Stroke M >=41.50 and M <50.50- Tier Tier 2",
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        {
          "code": "C0104",
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 33871.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 33871.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 33871.46,
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            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 33871.46,
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            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 34562.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 34562.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 34562.71,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 34562.71,
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 34562.71,
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 30688.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 30688.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 30688.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 30688.08,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 31314.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 31314.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 31314.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31314.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 31314.37,
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          "maximum": 31314.37
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    {
      "description": "Stroke M <41.50 and A >=84.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0105",
          "type": "LOCAL"
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      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 47534.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 47534.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
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              "estimated_amount": 47534.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 47534.97,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 48505.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 48505.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 48505.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 48505.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 48505.07,
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    {
      "description": "Stroke M <41.50 and A >=84.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0105",
          "type": "LOCAL"
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      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 42211.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 42211.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
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              "estimated_amount": 42211.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
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              "estimated_amount": 42211.72,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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            {
              "payer_name": "Medicare (CMS)",
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      "description": "Stroke M <41.50 and A >=84.50- Tier Tier 3",
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        {
          "code": "D0105",
          "type": "LOCAL"
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "payer_name": "Medicare (CMS)",
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        {
          "code": "B0106",
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        {
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        {
          "code": "C0106",
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        {
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            {
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    {
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            },
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              "payer_name": "Humana Insurance Company",
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            },
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 37415.87,
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 37415.87,
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            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 38179.46,
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            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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            {
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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            {
              "payer_name": "Medicare (CMS)",
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      "description": "Non-traumatic brain injury M >=65.50- Tier None",
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        {
          "code": "A0301",
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        {
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              "payer_name": "Humana Insurance Company",
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        {
          "code": "B0301",
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        {
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 22569,
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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        {
          "code": "C0301",
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        {
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            {
              "payer_name": "Humana Insurance Company",
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        {
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        {
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        {
          "code": "A0302",
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    {
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        {
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              "estimated_amount": 29792.44,
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            },
            {
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            {
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              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 29792.44,
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    {
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 23139.89,
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 23612.13,
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            },
            {
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              "estimated_amount": 23612.13,
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            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 23612.13,
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 23612.13,
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            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 23612.13,
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    {
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        {
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 21572.78,
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              "standard_charge_percentage": 100,
              "estimated_amount": 22013.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 22013.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 22013.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 22013.04,
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 22013.04,
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    {
      "description": "Non-traumatic brain injury M >=42.50 and M <52.50- Tier None",
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              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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            },
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              "payer_name": "Coventry Health Care",
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            },
            {
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            },
            {
              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24368.27,
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    {
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        {
          "code": "B0303",
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        {
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    {
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        {
          "code": "C0303",
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        {
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    {
      "description": "Non-traumatic brain injury M >=42.50 and M <52.50- Tier Tier 3",
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        {
          "code": "D0303",
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        {
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            {
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      "description": "Non-traumatic brain injury M <42.50 and A >=78.50- Tier None",
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        {
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        {
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      ],
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    {
      "description": "Non-traumatic brain injury M <42.50 and A >=78.50- Tier Tier 3",
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      ],
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Non-traumatic brain injury M <42.50 and A <78.50- Tier None",
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              "payer_name": "Medicare (CMS)",
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    {
      "description": "Non-traumatic brain injury M <42.50 and A <78.50- Tier Tier 1",
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    {
      "description": "Non-traumatic brain injury M <42.50 and A <78.50- Tier Tier 2",
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      ],
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              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Medicare (CMS)",
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          "minimum": 35506.62,
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      "description": "Non-traumatic brain injury M <42.50 and A <78.50- Tier Tier 3",
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        {
          "code": "D0305",
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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        {
          "code": "A0401",
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        {
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        {
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        {
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        {
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 27894.77,
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              "estimated_amount": 27894.77,
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    {
      "description": "Traumatic spinal cord injury M >=41.50 and M <47.50- Tier Tier 1",
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        {
          "code": "B0403",
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        {
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            {
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        {
          "code": "C0403",
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        {
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    {
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        {
          "code": "D0403",
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        {
          "setting": "inpatient",
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            {
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        {
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        {
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            {
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            {
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              "estimated_amount": 48765.47,
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            {
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    {
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            {
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            },
            {
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            },
            {
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    {
      "description": "Traumatic spinal cord injury M >=31.50 and M <41.50- Tier Tier 2",
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        {
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            },
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            },
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 39670.53,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 39670.53,
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            },
            {
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              "estimated_amount": 39670.53,
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 39670.53,
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 39670.53,
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      ]
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    {
      "description": "Traumatic spinal cord injury M >=31.50 and M <41.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0405",
          "type": "LOCAL"
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      ],
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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            {
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            {
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            {
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            {
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
      "description": "Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50- Tier None",
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        {
          "code": "A0406",
          "type": "LOCAL"
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      ],
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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            {
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            {
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            {
              "payer_name": "Coventry Health Care",
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            {
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            {
              "payer_name": "Coventry Health Care",
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 45982.02,
              "methodology": "fee schedule"
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          ],
          "minimum": 45062.38,
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      ]
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    {
      "description": "Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50- Tier Tier 1",
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        {
          "code": "B0406",
          "type": "LOCAL"
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      ],
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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            {
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              "payer_name": "Coventry Health Care",
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            {
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              "estimated_amount": 63847.84,
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            {
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "payer_name": "Medicare (CMS)",
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    {
      "description": "Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50- Tier Tier 2",
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        {
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        {
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            {
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            {
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            {
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            {
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            {
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    },
    {
      "description": "Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50- Tier Tier 3",
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        {
          "code": "D0406",
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        {
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 50814.01,
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            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 50814.01,
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            {
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              "estimated_amount": 50814.01,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 50814.01,
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "methodology": "fee schedule"
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          ],
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    {
      "description": "Traumatic spinal cord injury M <24.50 and A >=61.50- Tier None",
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        {
          "code": "A0407",
          "type": "LOCAL"
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        {
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 61708.88,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 61708.88,
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            },
            {
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            },
            {
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            },
            {
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            },
            {
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            {
              "payer_name": "Medicare (CMS)",
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    },
    {
      "description": "Traumatic spinal cord injury M <24.50 and A >=61.50- Tier Tier 1",
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        {
          "code": "B0407",
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      "standard_charges": [
        {
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 85686.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 85686.19,
              "methodology": "fee schedule"
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 85686.19,
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            {
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              "estimated_amount": 85686.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 87434.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 87434.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 87434.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 87434.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 87434.89,
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    {
      "description": "Traumatic spinal cord injury M <24.50 and A >=61.50- Tier Tier 2",
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          "code": "C0407",
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        {
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            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
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              "estimated_amount": 70037.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 70037.8,
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            {
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              "estimated_amount": 70037.8,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 70037.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 71467.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 71467.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 71467.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 71467.14,
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 71467.14,
              "methodology": "fee schedule"
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    {
      "description": "Traumatic spinal cord injury M <24.50 and A >=61.50- Tier Tier 3",
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        {
          "code": "D0407",
          "type": "LOCAL"
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      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 68194.7,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 68194.7,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 68194.7,
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            },
            {
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              "estimated_amount": 68194.7,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 69586.43,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 69586.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 69586.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "standard_charge_percentage": 100,
              "estimated_amount": 69586.43,
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            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 69586.43,
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          ],
          "minimum": 68194.7,
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    },
    {
      "description": "Non-traumatic spinal cord injury M >=60.50- Tier None",
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        {
          "code": "A0501",
          "type": "LOCAL"
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      ],
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        {
          "setting": "inpatient",
          "payers_information": [
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 16304.35,
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            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 16637.09,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 16637.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 16637.09,
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 16637.09,
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16637.09,
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    {
      "description": "Non-traumatic spinal cord injury M >=60.50- Tier Tier 1",
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        {
          "code": "B0501",
          "type": "LOCAL"
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        {
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            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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        {
          "code": "C0501",
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        {
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            {
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 19017.01,
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              "estimated_amount": 19405.11,
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 19405.11,
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            {
              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 19405.11,
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    {
      "description": "Non-traumatic spinal cord injury M >=60.50- Tier Tier 3",
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        {
          "code": "D0501",
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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    {
      "description": "Non-traumatic spinal cord injury M >=53.50 and M <60.50- Tier None",
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        {
          "code": "A0502",
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        {
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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            {
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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    {
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        {
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 30720.23,
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 31347.17,
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            },
            {
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              "estimated_amount": 31347.17,
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            {
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              "estimated_amount": 31347.17,
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            {
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              "estimated_amount": 31347.17,
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    {
      "description": "Non-traumatic spinal cord injury M >=53.50 and M <60.50- Tier Tier 2",
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        {
          "code": "C0502",
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      ],
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 23608.69,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 23608.69,
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 23608.69,
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            {
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              "estimated_amount": 23608.69,
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            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 24090.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 24090.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 24090.5,
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 24090.5,
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    {
      "description": "Non-traumatic spinal cord injury M >=53.50 and M <60.50- Tier Tier 3",
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          "code": "D0502",
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      ],
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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            {
              "payer_name": "Humana Insurance Company",
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            {
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            {
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            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 22410.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 22410.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 22410.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 22410.4,
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    {
      "description": "Non-traumatic spinal cord injury M >=48.50 and M <53.50- Tier None",
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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            },
            {
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            },
            {
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            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 23386.44,
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    {
      "description": "Non-traumatic spinal cord injury M >=48.50 and M <53.50- Tier Tier 1",
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        {
          "setting": "inpatient",
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              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35496.31,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 35496.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 35496.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 35496.31,
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        {
          "code": "C0503",
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        {
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        {
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        {
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        {
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        {
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    {
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        {
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        {
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            },
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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            },
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            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 43084.75,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 43084.75,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 43084.75,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 43084.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 43084.75,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 42223.06,
          "maximum": 43084.75
        }
      ]
    },
    {
      "description": "Neurological M >=64.50- Tier None",
      "code_information": [
        {
          "code": "A0601",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 15860.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 15860.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 15860.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 15860.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 16183.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 16183.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 16183.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16183.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16183.79,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15860.11,
          "maximum": 16183.79
        }
      ]
    },
    {
      "description": "Neurological M >=64.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0601",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 24754.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 24754.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 24754.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 24754.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25259.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 25259.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 25259.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25259.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25259.44,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24754.25,
          "maximum": 25259.44
        }
      ]
    },
    {
      "description": "Neurological M >=64.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0601",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 18748.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 18748.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 18748.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 18748.58,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19131.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 19131.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 19131.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19131.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19131.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18748.58,
          "maximum": 19131.2
        }
      ]
    },
    {
      "description": "Neurological M >=64.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0601",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 17657.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 17657.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
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              "estimated_amount": 17657.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 17657.85,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18018.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 18018.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 18018.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18018.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18018.21,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17657.85,
          "maximum": 18018.21
        }
      ]
    },
    {
      "description": "Neurological M >=52.50 and M <64.50- Tier None",
      "code_information": [
        {
          "code": "A0602",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 19729.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 19729.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 19729.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 19729.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 20132.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 20132.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 20132.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20132.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20132.32,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19729.67,
          "maximum": 20132.32
        }
      ]
    },
    {
      "description": "Neurological M >=52.50 and M <64.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0602",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 30792.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 30792.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 30792.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 30792.06,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31420.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 31420.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 31420.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31420.47,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31420.47,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30792.06,
          "maximum": 31420.47
        }
      ]
    },
    {
      "description": "Neurological M >=52.50 and M <64.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0602",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23321.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23321.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23321.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23321.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23797.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 23797.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 23797.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23797.3,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23797.3,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23321.35,
          "maximum": 23797.3
        }
      ]
    },
    {
      "description": "Neurological M >=52.50 and M <64.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0602",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 21964.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 21964.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 21964.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 21964.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22412.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 22412.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 22412.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22412.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22412.33,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21964.08,
          "maximum": 22412.33
        }
      ]
    },
    {
      "description": "Neurological M >=43.50 and M <52.50- Tier None",
      "code_information": [
        {
          "code": "A0603",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23461.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23461.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23461.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23461.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23940.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 23940.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 23940.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23940.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23940.05,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23461.25,
          "maximum": 23940.05
        }
      ]
    },
    {
      "description": "  Neurological M >=43.50 and M <52.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0603",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 36616.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 36616.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 36616.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 36616.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 37363.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 37363.52,
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      ]
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    {
      "description": "Neurological M >=43.50 and M <52.50- Tier Tier 2",
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        {
          "code": "C0603",
          "type": "LOCAL"
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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            },
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              "methodology": "fee schedule"
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              "estimated_amount": 28297.52,
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            {
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              "estimated_amount": 28297.52,
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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            {
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              "estimated_amount": 28297.52,
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      "description": "Neurological M >=43.50 and M <52.50- Tier Tier 3",
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        {
          "code": "D0603",
          "type": "LOCAL"
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 26652.13,
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            {
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              "estimated_amount": 26652.13,
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            {
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "payer_name": "Medicare (CMS)",
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      "description": "Neurological M <43.50- Tier None",
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        {
          "code": "A0604",
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        {
          "setting": "inpatient",
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            },
            {
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            },
            {
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              "estimated_amount": 30276.61,
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            },
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            },
            {
              "payer_name": "Coventry Health Care",
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              "payer_name": "Medicare (CMS)",
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          ],
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    {
      "description": "Neurological M <43.50- Tier Tier 1",
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        {
          "code": "B0604",
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        {
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            {
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            {
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            {
              "payer_name": "Coventry Health Care",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "payer_name": "Medicare (CMS)",
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          ],
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    {
      "description": "Neurological M <43.50- Tier Tier 2",
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        {
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        {
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            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 35787.58,
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            },
            {
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            {
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            {
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    {
      "description": "Neurological M <43.50- Tier Tier 3",
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        {
          "code": "D0604",
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      ],
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        {
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            {
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              "estimated_amount": 33034.03,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33708.19,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33708.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33708.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 33708.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 33708.19,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 33034.03,
          "maximum": 33708.19
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      ]
    },
    {
      "description": "Fracture of lower extremity M >=61.50- Tier None",
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        {
          "code": "A0701",
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        {
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 16092.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 16092.63,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 16092.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 16092.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 16421.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 16421.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 16421.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 16421.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 16421.05,
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          "minimum": 16092.63,
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      ]
    },
    {
      "description": "Fracture of lower extremity M >=61.50- Tier Tier 1",
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        {
          "code": "B0701",
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      ],
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        {
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            },
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              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 23192.82,
              "methodology": "fee schedule"
            },
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              "payer_name": "Coventry Health Care",
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              "estimated_amount": 23666.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 23666.14,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 23666.14,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 23666.14,
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            },
            {
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              "standard_charge_percentage": 100,
              "estimated_amount": 23666.14,
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            }
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    {
      "description": "Fracture of lower extremity M >=61.50- Tier Tier 2",
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        {
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        {
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              "methodology": "fee schedule"
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              "payer_name": "Humana Insurance Company",
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            },
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            },
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              "payer_name": "Humana Insurance Company",
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            },
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              "standard_charge_percentage": 100,
              "estimated_amount": 18920.95,
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            },
            {
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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            }
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      ]
    },
    {
      "description": "Fracture of lower extremity M >=61.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0701",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
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            },
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              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Humana Insurance Company",
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            },
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              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28449.9,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28449.9,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27880.9,
          "maximum": 28449.9
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M <42.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0805",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 39527.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 39527.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 39527.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 39527.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 40334.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 40334.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 40334.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 40334.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 40334.09,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 39527.41,
          "maximum": 40334.09
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M <42.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0805",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 33291.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 33291.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 33291.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 33291.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 33970.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 33970.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 33970.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33970.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 33970.52,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 33291.11,
          "maximum": 33970.52
        }
      ]
    },
    {
      "description": "Replacement of lower-extremity joint M <42.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0805",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 29758.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 29758.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 29758.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 29758.03,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30365.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 30365.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 30365.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30365.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30365.34,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29758.03,
          "maximum": 30365.34
        }
      ]
    },
    {
      "description": "Other orthopedic M >=63.50- Tier None",
      "code_information": [
        {
          "code": "A0901",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 15281.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 15281.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 15281.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 15281.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 15593.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 15593.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 15593.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 15593.53,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 15593.53,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15281.66,
          "maximum": 15593.53
        }
      ]
    },
    {
      "description": "Other orthopedic M >=63.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0901",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23412.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23412.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
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              "estimated_amount": 23412.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23412.09,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23889.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 23889.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 23889.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23889.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23889.89,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23412.09,
          "maximum": 23889.89
        }
      ]
    },
    {
      "description": "Other orthopedic M >=63.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0901",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 17733.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 17733.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
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              "estimated_amount": 17733.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 17733.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 18095.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 18095.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 18095.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18095.36,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18095.36,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 17733.45,
          "maximum": 18095.36
        }
      ]
    },
    {
      "description": "Other orthopedic M >=63.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0901",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 16752.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 16752.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 16752.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 16752.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 17094.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 17094.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 17094.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 17094.25,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 17094.25,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16752.37,
          "maximum": 17094.25
        }
      ]
    },
    {
      "description": "Other orthopedic M >=51.50 and M <63.50- Tier None",
      "code_information": [
        {
          "code": "A0902",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 19413.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 19413.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 19413.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 19413.99,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 19810.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 19810.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 19810.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19810.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 19810.19,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19413.99,
          "maximum": 19810.19
        }
      ]
    },
    {
      "description": "Other orthopedic M >=51.50 and M <63.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0902",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 29741.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 29741.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 29741.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 29741.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30347.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 30347.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 30347.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30347.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30347.98,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 29741.02,
          "maximum": 30347.98
        }
      ]
    },
    {
      "description": "Other orthopedic M >=51.50 and M <63.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0902",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 22527.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 22527.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 22527.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 22527.41,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 22987.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 22987.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 22987.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22987.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22987.15,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22527.41,
          "maximum": 22987.15
        }
      ]
    },
    {
      "description": "Other orthopedic M >=51.50 and M <63.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0902",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 21279.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 21279.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 21279.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 21279.77,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 21714.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 21714.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 21714.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21714.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21714.05,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21279.77,
          "maximum": 21714.05
        }
      ]
    },
    {
      "description": "Other orthopedic M >=44.50 and M <51.50- Tier None",
      "code_information": [
        {
          "code": "A0903",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23037.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23037.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23037.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 23037.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23507.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 23507.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 23507.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23507.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 23507.96,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23037.8,
          "maximum": 23507.96
        }
      ]
    },
    {
      "description": "Other orthopedic M >=44.50 and M <51.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B0903",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 35293,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 35293,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 35293,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 35293,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 36013.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 36013.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 36013.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36013.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36013.27,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 35293,
          "maximum": 36013.27
        }
      ]
    },
    {
      "description": "Other orthopedic M >=44.50 and M <51.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C0903",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 26731.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 26731.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 26731.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 26731.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 27277.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 27277.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 27277.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27277.11,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27277.11,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 26731.57,
          "maximum": 27277.11
        }
      ]
    },
    {
      "description": "Other orthopedic M >=44.50 and M <51.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0903",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 25251.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 25251.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 25251.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 25251.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25766.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 25766.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 25766.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25766.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25766.75,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25251.42,
          "maximum": 25766.75
        }
      ]
    },
    {
      "description": "Other orthopedic M <44.5- Tier None",
      "code_information": [
        {
          "code": "A0904",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 27741.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 27741.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 27741.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 27741.02,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 28307.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 28307.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 28307.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28307.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 28307.16,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27741.02,
          "maximum": 28307.16
        }
      ]
    },
    {
      "description": "Other orthopedic M <44.5- Tier Tier 1",
      "code_information": [
        {
          "code": "B0904",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 42499.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 42499.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 42499.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 42499.05,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 43366.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 43366.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 43366.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 43366.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 43366.38,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 42499.05,
          "maximum": 43366.38
        }
      ]
    },
    {
      "description": "Other orthopedic M <44.5- Tier Tier 2",
      "code_information": [
        {
          "code": "C0904",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 32190.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 32190.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 32190.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 32190.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 32847.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 32847.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 32847.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32847.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32847.88,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32190.92,
          "maximum": 32847.88
        }
      ]
    },
    {
      "description": "Other orthopedic M <44.5- Tier Tier 3",
      "code_information": [
        {
          "code": "D0904",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 30408.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 30408.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 30408.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 30408.31,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 31028.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 31028.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 31028.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31028.89,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31028.89,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 30408.31,
          "maximum": 31028.89
        }
      ]
    },
    {
      "description": "Amputation lower extremity M >=64.50- Tier None",
      "code_information": [
        {
          "code": "A1001",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 16266.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 16266.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 16266.54,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 16266.54,
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    {
      "description": "Amputation lower extremity M >=47.50 and M <55.50- Tier Tier 3",
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        {
          "code": "D1003",
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        {
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        {
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        {
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    {
      "description": "Amputation lower extremity M <47.50- Tier Tier 1",
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        {
          "code": "B1004",
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        {
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        {
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    {
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        {
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        {
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    {
      "description": "Amputation non-lower extremity M >=58.50- Tier None",
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        {
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        {
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    {
      "description": "Amputation non-lower extremity M >=58.50- Tier Tier 1",
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        {
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        {
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    {
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            {
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    {
      "description": "Amputation non-lower extremity M >=58.50- Tier Tier 3",
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        {
          "code": "D1101",
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        {
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            },
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            {
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    {
      "description": "Amputation non-lower extremity M >=52.50 and M <58.50- Tier None",
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        {
          "code": "A1102",
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      "description": "Amputation non-lower extremity M >=52.50 and M <58.50- Tier Tier 1",
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        {
          "code": "B1102",
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        {
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      ]
    },
    {
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        {
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        {
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        {
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        {
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    {
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        {
          "code": "B1103",
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        {
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            {
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    {
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        {
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        {
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            },
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              "estimated_amount": 35444.01,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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            {
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            {
              "payer_name": "Medicare (CMS)",
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    {
      "description": "Amputation non-lower extremity M <52.50- Tier Tier 3",
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        {
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            },
            {
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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          ],
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          "code": "A1201",
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        {
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            },
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            },
            {
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            {
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            },
            {
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    {
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        {
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            },
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            },
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            },
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            },
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            },
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 27460.36,
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              "payer_name": "Medicare (CMS)",
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      "description": "Cardiac M >=55.50 and M <68.50- Tier Tier 2",
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        {
          "code": "C1402",
          "type": "LOCAL"
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        {
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            {
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        {
          "code": "D1402",
          "type": "LOCAL"
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        {
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            {
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              "estimated_amount": 20452.53,
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              "estimated_amount": 20452.53,
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        {
          "code": "A1403",
          "type": "LOCAL"
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        {
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        {
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        {
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              "estimated_amount": 33191.23,
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        {
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              "estimated_amount": 26737.01,
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              "estimated_amount": 28365.03,
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              "estimated_amount": 40582.22,
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      "description": "Cardiac M <45.50- Tier Tier 2",
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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      "description": "Cardiac M <45.50- Tier Tier 3",
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          "code": "D1404",
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
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              "estimated_amount": 30228.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
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              "estimated_amount": 30228.73,
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            {
              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 30228.73,
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            },
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              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
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              "estimated_amount": 30845.64,
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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              "estimated_amount": 30845.64,
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            },
            {
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              "estimated_amount": 30845.64,
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              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 30845.64,
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    {
      "description": "Pulmonary M >=68.50- Tier None",
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        {
          "code": "A1501",
          "type": "LOCAL"
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        {
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            },
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 17829.87,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 18193.74,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 18193.74,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 18193.74,
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18193.74,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18193.74,
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    {
      "description": "Pulmonary M >=68.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1501",
          "type": "LOCAL"
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      ],
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 24769.37,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
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              "estimated_amount": 24769.37,
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            {
              "payer_name": "Humana Insurance Company",
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 24769.37,
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            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25274.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 25274.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Advantra Freedom",
              "standard_charge_percentage": 100,
              "estimated_amount": 25274.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25274.87,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25274.87,
              "methodology": "fee schedule"
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    {
      "description": "Pulmonary M >=68.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1501",
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 19916.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 19916.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 19916.82,
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            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Humana Medicare Advantage",
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              "estimated_amount": 19916.82,
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            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 20323.29,
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 20323.29,
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            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 20323.29,
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            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 20323.29,
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      ]
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    {
      "description": "Pulmonary M >=68.50- Tier Tier 3",
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        {
          "code": "D1501",
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        {
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 18652.17,
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            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
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              "estimated_amount": 18652.17,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 18652.17,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 18652.17,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 19032.83,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 19032.83,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 19032.83,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "estimated_amount": 19032.83,
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 19032.83,
              "methodology": "fee schedule"
            }
          ],
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      ]
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    {
      "description": "Pulmonary M >=56.50 and M <68.50- Tier None",
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        {
          "code": "A1502",
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        }
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 21803.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 21803.4,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 21803.4,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 21803.4,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 22248.37,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 22248.37,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "estimated_amount": 22248.37,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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              "estimated_amount": 22248.37,
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 22248.37,
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            }
          ],
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      ]
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    {
      "description": "Pulmonary M >=56.50 and M <68.50- Tier Tier 1",
      "code_information": [
        {
          "code": "B1502",
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "ChoiceCare Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 30287.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "HBHN Medicare Advantage",
              "standard_charge_percentage": 98,
              "estimated_amount": 30287.33,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 30287.33,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 30287.33,
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            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 30905.44,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 30905.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 30905.44,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 30905.44,
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 30905.44,
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            }
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    {
      "description": "Pulmonary M >=56.50 and M <68.50- Tier Tier 2",
      "code_information": [
        {
          "code": "C1502",
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 24353.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 24353.49,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 24353.49,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 24353.49,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24850.5,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24850.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24850.5,
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
              "plan_name": "Medicare",
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              "estimated_amount": 24850.5,
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 24850.5,
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            }
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    {
      "description": "Pulmonary M >=56.50 and M <68.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D1502",
          "type": "LOCAL"
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        {
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          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 22807.18,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 22807.18,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 22807.18,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 22807.18,
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            },
            {
              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 23272.63,
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            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
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              "estimated_amount": 23272.63,
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            },
            {
              "payer_name": "Coventry Health Care",
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              "standard_charge_percentage": 100,
              "estimated_amount": 23272.63,
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            },
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              "payer_name": "First Choice Health Network fka Health InfoNet",
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            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 23272.63,
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    {
      "description": "Pulmonary M >=45.50 and M <56.50- Tier None",
      "code_information": [
        {
          "code": "A1503",
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        {
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          "payers_information": [
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            },
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            },
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 25417.77,
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            },
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              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 25417.77,
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            },
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              "payer_name": "Coventry Health Care",
              "plan_name": "Altius Advantra",
              "standard_charge_percentage": 100,
              "estimated_amount": 25936.5,
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 25936.5,
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            },
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              "payer_name": "Coventry Health Care",
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            },
            {
              "payer_name": "First Choice Health Network fka Health InfoNet",
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            },
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              "payer_name": "Medicare (CMS)",
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      "description": "Pulmonary M >=45.50 and M <56.50- Tier Tier 1",
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        {
          "code": "B1503",
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        {
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        {
          "code": "C1503",
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        {
          "code": "D1503",
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    {
      "description": "Pulmonary M <45.50- Tier None",
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        {
          "code": "A1504",
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        {
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        {
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    {
      "description": "Pulmonary M <45.50- Tier Tier 2",
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        {
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        {
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    {
      "description": "Pulmonary M <45.50- Tier Tier 3",
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    {
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        {
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    {
      "description": "Pain syndrome M >=65.50- Tier Tier 1",
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        {
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        {
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            },
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            },
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              "estimated_amount": 23852.03,
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            },
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    {
      "description": "Pain syndrome M >=65.50- Tier Tier 2",
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        {
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        {
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            },
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            },
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            },
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            },
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          "code": "D1601",
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            },
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            },
            {
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    {
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        {
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        {
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        {
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        {
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            {
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        {
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            {
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