{
  "hospital_name": "Northern Colorado Rehabilitation Hospital",
  "last_updated_on": "2026-01-01",
  "version": "2.0.0",
  "hospital_location": [
    "Northern Colorado Rehabilitation Hospital"
  ],
  "hospital_address": [
    "4401 Union St, Johnstown, CO 80534"
  ],
  "license_information": {
    "state": "CO"
  },
  "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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    },
    {
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      "description": "Speech Therapy - Language Pathology - Evaluation or Reevaluation",
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              "estimated_amount": 299,
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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      "description": "Ther ivntj ea addl 15 min",
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        {
          "code": "97130",
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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": 131.1,
              "methodology": "fee schedule"
            },
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              "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": 18.22,
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    {
      "description": "Aquatic therapy/exercises",
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        {
          "code": "97113",
          "type": "HCPCS"
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        {
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            },
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            },
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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"
            },
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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": "Cigna Health and Life Insurance Company",
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              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Claritev fka MultiPlan",
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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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              "methodology": "fee schedule"
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          ],
          "minimum": 31.81,
          "maximum": 74.75
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    {
      "description": "Oral function therapy",
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        {
          "code": "92526",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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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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              "methodology": "percent of total billed charges"
            },
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              "methodology": "percent of total billed charges"
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            {
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              "methodology": "percent of total billed charges"
            },
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              "methodology": "percent of total billed charges"
            },
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            },
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            },
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            },
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            },
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      "description": "Ot eval mod complex 45 min",
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          "code": "97166",
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        }
      ],
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            },
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              "methodology": "fee schedule"
            },
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              "estimated_amount": 151.79,
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            },
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              "plan_name": "MA HMO (including POS)",
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              "methodology": "fee schedule"
            },
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      "description": "Pt eval low complex 20 min",
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      "description": "Ot eval low complex 30 min",
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      "description": "Ot eval high complex 60 min",
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        {
          "code": "97167",
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      "description": "Glucose other fluid",
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        {
          "code": "82945",
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      "description": "Behavral qualit analys voice",
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        {
          "code": "92524",
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      "description": "Debride nail 6 or more",
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          "code": "82962",
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    {
      "description": "Assessment of aphasia",
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          "code": "96105",
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        }
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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"
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          ],
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      ]
    },
    {
      "description": "Physical performance test",
      "code_information": [
        {
          "code": "97750",
          "type": "HCPCS"
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Pinnacol Assurance",
              "plan_name": "SelectNet Network (Workers' Comp)",
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              "estimated_amount": 205.25,
              "methodology": "fee schedule"
            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 103.79,
              "methodology": "fee schedule"
            },
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              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
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              "estimated_amount": 103.79,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 299,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 299,
              "methodology": "fee schedule"
            }
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          "minimum": 90.91,
          "maximum": 299
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      ]
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    {
      "description": "Wheelchair mngment training",
      "code_information": [
        {
          "code": "97542",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Colorado Medicaid",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Denver Health Medical Plan",
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              "estimated_amount": 27.82,
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            },
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              "payer_name": "WellCare",
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              "estimated_amount": 31.59,
              "methodology": "fee schedule"
            },
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              "payer_name": "WellCare",
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            },
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              "payer_name": "Health InfoNet",
              "plan_name": "Workers Compensation",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Devoted Health",
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            },
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              "payer_name": "Devoted Health",
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            },
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              "payer_name": "Devoted Health",
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            },
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              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
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              "methodology": "fee schedule"
            },
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              "payer_name": "Aetna Network Services",
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              "estimated_amount": 27.38,
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            },
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              "payer_name": "Aetna Network Services",
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              "payer_name": "Claritev fka MultiPlan",
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              "estimated_amount": 42.69,
              "methodology": "fee schedule"
            },
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              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "HMO",
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              "estimated_amount": 44.85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "PPO",
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              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "Indemnity",
              "standard_charge_percentage": 60,
              "estimated_amount": 44.85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
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              "estimated_amount": 59.8,
              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Claritev fka MultiPlan",
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              "methodology": "percent of total billed charges"
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              "payer_name": "Aetna Network Services",
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              "estimated_amount": 31.59,
              "methodology": "fee schedule"
            },
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "estimated_amount": 31.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.59,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 46.48,
              "methodology": "fee schedule"
            },
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              "plan_name": "VA CCN",
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              "estimated_amount": 31.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 31.59,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 74.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 74.75,
              "methodology": "fee schedule"
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          "minimum": 27.38,
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    {
      "description": "Endoscopy swallow (fees) vid",
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        {
          "code": "92612",
          "type": "HCPCS"
        }
      ],
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        {
          "setting": "outpatient",
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              "estimated_amount": 68.99,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 68.99,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 65.23,
              "methodology": "fee schedule"
            },
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              "estimated_amount": 65.23,
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            },
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              "plan_name": "MA HMO (including POS)",
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            },
            {
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              "estimated_amount": 65.23,
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            },
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              "estimated_amount": 65.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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            },
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            },
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            },
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            },
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              "methodology": "percent of total billed charges"
            },
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              "methodology": "percent of total billed charges"
            },
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 65.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
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              "estimated_amount": 65.23,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 299,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Vent mgmt inpat subq day",
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        {
          "code": "94003",
          "type": "HCPCS"
        }
      ],
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            },
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            },
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            },
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              "estimated_amount": 62.18,
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            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 55.96,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
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            },
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            },
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            },
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              "methodology": "fee schedule"
            },
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            },
            {
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              "estimated_amount": 68.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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            },
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              "methodology": "percent of total billed charges"
            },
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              "methodology": "percent of total billed charges"
            },
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              "estimated_amount": 62.18,
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            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "estimated_amount": 62.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
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              "estimated_amount": 62.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 62.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 62.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
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              "estimated_amount": 62.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "estimated_amount": 62.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 297.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
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              "methodology": "fee schedule"
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          ],
          "minimum": 47.35,
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    },
    {
      "description": "Orthotic mgmt&traing 1st enc",
      "code_information": [
        {
          "code": "97760",
          "type": "HCPCS"
        }
      ],
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        {
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              "estimated_amount": 43.02,
              "methodology": "fee schedule"
            },
            {
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            },
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              "estimated_amount": 47.57,
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            },
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            },
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              "methodology": "fee schedule"
            },
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            },
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            },
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            },
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              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
            },
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              "estimated_amount": 42.12,
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            },
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              "payer_name": "Claritev fka MultiPlan",
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              "estimated_amount": 64.26,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "estimated_amount": 44.85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "estimated_amount": 44.85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
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              "standard_charge_percentage": 60,
              "estimated_amount": 44.85,
              "methodology": "percent of total billed charges"
            },
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              "payer_name": "Claritev fka MultiPlan",
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              "estimated_amount": 59.8,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
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              "standard_charge_percentage": 75,
              "estimated_amount": 56.06,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Aetna Network Services",
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              "standard_charge_percentage": 100,
              "estimated_amount": 47.57,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "estimated_amount": 47.57,
              "methodology": "fee schedule"
            },
            {
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      "description": "Ot re-eval est plan care",
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        {
          "code": "97168",
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        {
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      "description": "Electric stimulation therapy",
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        {
          "code": "97014",
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      "description": "Complete cbc w/auto diff wbc",
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      "description": "Pt re-eval est plan care",
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        {
          "code": "97164",
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              "payer_name": "TRU Community Care dba Tru Pace",
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      "description": "Canalith repositioning proc",
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          "code": "95992",
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            },
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            },
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    {
      "description": "Comprehen metabolic panel",
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        {
          "code": "80053",
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    {
      "description": "Sensory integration",
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          "code": "97533",
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            },
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              "methodology": "percent of total billed charges"
            },
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            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "Indemnity",
              "standard_charge_percentage": 60,
              "estimated_amount": 44.85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "MPI Complementary Network",
              "standard_charge_percentage": 80,
              "estimated_amount": 59.8,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "PHCS Primary Network",
              "standard_charge_percentage": 75,
              "estimated_amount": 56.06,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 62.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 62.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 62.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 62.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Pinnacol Assurance",
              "plan_name": "SelectNet Network (Workers' Comp)",
              "standard_charge_percentage": 98,
              "estimated_amount": 91.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 62.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 62.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 141.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 141.45,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 44.85,
          "maximum": 141.45
        }
      ]
    },
    {
      "description": "Community/work reintegration",
      "code_information": [
        {
          "code": "97537",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Colorado Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Colorado CHP+",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellCare",
              "plan_name": "Medicare Advantage Plan",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellCare",
              "plan_name": "Medicare Advantage Prescription Drug Plan (MA-PD Plan)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Health InfoNet",
              "plan_name": "Workers Compensation",
              "standard_charge_percentage": 100,
              "estimated_amount": 47.43,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "Workers' Compensation",
              "standard_charge_percentage": 90,
              "estimated_amount": 42.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "HMO",
              "standard_charge_percentage": 60,
              "estimated_amount": 44.85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "PPO",
              "standard_charge_percentage": 60,
              "estimated_amount": 44.85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Cigna Health and Life Insurance Company",
              "plan_name": "Indemnity",
              "standard_charge_percentage": 60,
              "estimated_amount": 44.85,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "MPI Complementary Network",
              "standard_charge_percentage": 80,
              "estimated_amount": 59.8,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "PHCS Primary Network",
              "standard_charge_percentage": 75,
              "estimated_amount": 56.06,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Pinnacol Assurance",
              "plan_name": "SelectNet Network (Workers' Comp)",
              "standard_charge_percentage": 98,
              "estimated_amount": 46.48,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 118.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 118.45,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27.38,
          "maximum": 118.45
        }
      ]
    },
    {
      "description": "Metabolic panel total ca",
      "code_information": [
        {
          "code": "80048",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "WellCare",
              "plan_name": "Medicare Advantage Plan",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellCare",
              "plan_name": "Medicare Advantage Prescription Drug Plan (MA-PD Plan)",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 90,
              "estimated_amount": 7.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 90,
              "estimated_amount": 7.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 90,
              "estimated_amount": 7.61,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "POS",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "EPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 6.35,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "MPI Complementary Network",
              "standard_charge_percentage": 80,
              "estimated_amount": 74.02,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "PHCS Primary Network",
              "standard_charge_percentage": 75,
              "estimated_amount": 69.39,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 8.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 92.52,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 92.52,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 6.35,
          "maximum": 92.52
        }
      ]
    },
    {
      "description": "Ndl insj w/o njx 3+ musc",
      "code_information": [
        {
          "code": "20561",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Colorado Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Colorado CHP+",
              "standard_charge_percentage": 100,
              "estimated_amount": 31.16,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellCare",
              "plan_name": "Medicare Advantage Plan",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellCare",
              "plan_name": "Medicare Advantage Prescription Drug Plan (MA-PD Plan)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Health InfoNet",
              "plan_name": "Workers Compensation",
              "standard_charge_percentage": 100,
              "estimated_amount": 44.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "Workers' Compensation",
              "standard_charge_percentage": 90,
              "estimated_amount": 40.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "MPI Complementary Network",
              "standard_charge_percentage": 80,
              "estimated_amount": 119.6,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "PHCS Primary Network",
              "standard_charge_percentage": 75,
              "estimated_amount": 112.13,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Pinnacol Assurance",
              "plan_name": "SelectNet Network (Workers' Comp)",
              "standard_charge_percentage": 98,
              "estimated_amount": 43.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22.24,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Prime",
              "standard_charge_percentage": 100,
              "estimated_amount": 149.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "TRICARE Select",
              "standard_charge_percentage": 100,
              "estimated_amount": 149.5,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 22.24,
          "maximum": 149.5
        }
      ]
    },
    {
      "description": "Ndl insj w/o njx 1 or 2 musc",
      "code_information": [
        {
          "code": "20560",
          "type": "HCPCS"
        }
      ],
      "standard_charges": [
        {
          "setting": "outpatient",
          "payers_information": [
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Colorado Medicaid",
              "standard_charge_percentage": 100,
              "estimated_amount": 21.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Colorado CHP+",
              "standard_charge_percentage": 100,
              "estimated_amount": 21.46,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellCare",
              "plan_name": "Medicare Advantage Plan",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "WellCare",
              "plan_name": "Medicare Advantage Prescription Drug Plan (MA-PD Plan)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Health InfoNet",
              "plan_name": "Workers Compensation",
              "standard_charge_percentage": 100,
              "estimated_amount": 29.92,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "Workers' Compensation",
              "standard_charge_percentage": 90,
              "estimated_amount": 26.93,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "MPI Complementary Network",
              "standard_charge_percentage": 80,
              "estimated_amount": 119.6,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Claritev fka MultiPlan",
              "plan_name": "PHCS Primary Network",
              "standard_charge_percentage": 75,
              "estimated_amount": 112.13,
              "methodology": "percent of total billed charges"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Pinnacol Assurance",
              "plan_name": "SelectNet Network (Workers' Comp)",
              "standard_charge_percentage": 98,
              "estimated_amount": 29.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 14.72,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
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              "payer_name": "TRU Community Care dba Tru Pace",
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        {
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      "description": "Sbsq hosp ip/obs moderate 35",
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      "description": "Application of finger splint",
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          "code": "29130",
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      "description": "Prosthetic traing 1st enc",
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          "code": "97761",
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      "description": "Mechanical traction therapy",
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              "payer_name": "Cigna Health and Life Insurance Company",
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              "payer_name": "Cigna Health and Life Insurance Company",
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              "payer_name": "TRU Community Care dba Tru Pace",
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              "payer_name": "Pinnacol Assurance",
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    {
      "description": "Mri lumbar spine w/o & w/dye",
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        {
          "code": "72158",
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        {
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      "description": "Ct abd & pelv w/contrast",
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        {
          "code": "74177",
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        {
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      "description": "Unlisted e&m service",
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      "description": "Caregiver traing 1st 30 min",
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    {
      "description": "Prothrombin time",
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        {
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      "description": "X-ray exam abdomen 1 view",
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        {
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            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16227.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 16227.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 16227.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 16227.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 16227.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16227.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 16227.2,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16227.2,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 15902.66,
          "maximum": 16227.2
        }
      ]
    },
    {
      "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": "Medicare PPO",
              "standard_charge_percentage": 98,
              "estimated_amount": 18122.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 18122.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 18122.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 18491.88,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 18122.04,
          "maximum": 18491.88
        }
      ]
    },
    {
      "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": "Medicare PPO",
              "standard_charge_percentage": 98,
              "estimated_amount": 27165.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 27165.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 27165.98,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 27720.39,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 27165.98,
          "maximum": 27720.39
        }
      ]
    },
    {
      "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": "Medicare PPO",
              "standard_charge_percentage": 98,
              "estimated_amount": 21250.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 21250.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 21250.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21684.5,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21250.81,
          "maximum": 21684.5
        }
      ]
    },
    {
      "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": "Medicare PPO",
              "standard_charge_percentage": 98,
              "estimated_amount": 19806.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 19806.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 19806.08,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 20210.29,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 19806.08,
          "maximum": 20210.29
        }
      ]
    },
    {
      "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": "Medicare PPO",
              "standard_charge_percentage": 98,
              "estimated_amount": 21640.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 21640.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 21640.8,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 22082.45,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 21640.8,
          "maximum": 22082.45
        }
      ]
    },
    {
      "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": "Medicare PPO",
              "standard_charge_percentage": 98,
              "estimated_amount": 32237.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 32237.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 32237.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 32895.17,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 32237.27,
          "maximum": 32895.17
        }
      ]
    },
    {
      "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": "Medicare PPO",
              "standard_charge_percentage": 98,
              "estimated_amount": 25375.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 25375.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 25375.82,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25893.69,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25375.82,
          "maximum": 25893.69
        }
      ]
    },
    {
      "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": "Medicare PPO",
              "standard_charge_percentage": 98,
              "estimated_amount": 23652.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 23652.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 23652.78,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
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              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 24135.49,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 23652.78,
          "maximum": 24135.49
        }
      ]
    },
    {
      "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": "Medicare PPO",
              "standard_charge_percentage": 98,
              "estimated_amount": 25930.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 25930.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 25930.66,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26459.86,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 25930.66,
          "maximum": 26459.86
        }
      ]
    },
    {
      "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": "Medicare PPO",
              "standard_charge_percentage": 98,
              "estimated_amount": 38819.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 38819.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 38819.4,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 39611.63,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 38819.4,
          "maximum": 39611.63
        }
      ]
    },
    {
      "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": "Medicare PPO",
              "standard_charge_percentage": 98,
              "estimated_amount": 30406.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 30406.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 30406.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31027.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31027.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 31027.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31027.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31027.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31027.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31027.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 31027.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 31027.21,
              "methodology": "fee schedule"
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      "description": "Other orthopedic M <44.5- Tier Tier 3",
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        {
          "code": "D0904",
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              "payer_name": "Medicare (CMS)",
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      "description": "Amputation lower extremity M >=64.50- Tier None",
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        {
          "code": "A1001",
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        {
          "setting": "inpatient",
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              "payer_name": "Devoted Health",
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "payer_name": "SelectHealth",
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              "payer_name": "Denver Health Medical Plan",
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            {
              "payer_name": "Medicare (CMS)",
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    {
      "description": "Amputation lower extremity M >=64.50- Tier Tier 1",
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        {
          "code": "B1001",
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        {
          "setting": "inpatient",
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            {
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              "estimated_amount": 21467.08,
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              "payer_name": "Devoted Health",
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              "payer_name": "SelectHealth",
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            {
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      ]
    },
    {
      "description": "Amputation lower extremity M >=64.50- Tier Tier 2",
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        {
          "code": "C1001",
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      ],
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        {
          "setting": "inpatient",
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            {
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              "payer_name": "Devoted Health",
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            {
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    {
      "description": "Amputation lower extremity M >=64.50- Tier Tier 3",
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        {
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "methodology": "fee schedule"
            },
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              "payer_name": "TRU Community Care dba Tru Pace",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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            },
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            },
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            },
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              "methodology": "fee schedule"
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      ]
    },
    {
      "description": "Amputation lower extremity M >=55.50 and M <64.50- Tier None",
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        {
          "code": "A1002",
          "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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            },
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              "payer_name": "Humana Insurance Company",
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            },
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              "payer_name": "Devoted Health",
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      "description": "Amputation lower extremity M >=55.50 and M <64.50- Tier Tier 1",
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      "description": "Amputation lower extremity M >=47.50 and M <55.50- Tier None",
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      "description": "Amputation lower extremity M >=47.50 and M <55.50- Tier Tier 1",
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      "description": "Amputation non-lower extremity M >=52.50 and M <58.50- Tier Tier 1",
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      "description": "Amputation non-lower extremity M <52.50- Tier Tier 2",
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          "code": "C1401",
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        {
          "setting": "inpatient",
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              "payer_name": "Humana Insurance Company",
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        {
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      "description": "Cardiac M >=55.50 and M <68.50- Tier Tier 3",
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      "description": "Cardiac M >=45.50 and M <55.50- Tier Tier 3",
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              "payer_name": "United Healthcare (UHC)",
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      "description": "Pulmonary M >=68.50- Tier Tier 3",
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        {
          "code": "D1501",
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        {
          "setting": "inpatient",
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "TRU Community Care dba Tru Pace",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "Denver Health Medical Plan",
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              "payer_name": "Medicare (CMS)",
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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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        {
          "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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              "payer_name": "Devoted Health",
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    {
      "description": "Pulmonary M >=56.50 and M <68.50- Tier Tier 1",
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        {
          "code": "B1502",
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        {
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              "payer_name": "Devoted Health",
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              "payer_name": "Devoted Health",
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            },
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              "payer_name": "TRU Community Care dba Tru Pace",
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            },
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              "payer_name": "SelectHealth",
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            },
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              "payer_name": "SelectHealth",
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "Denver Health Medical Plan",
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    {
      "description": "Pulmonary M >=56.50 and M <68.50- Tier Tier 2",
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          "code": "C1502",
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        {
          "setting": "inpatient",
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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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            },
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            {
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    {
      "description": "Pulmonary M >=56.50 and M <68.50- Tier Tier 3",
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        {
          "code": "D1502",
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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": "Denver Health Medical Plan",
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      "description": "Pulmonary M <45.50- Tier Tier 1",
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    {
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      "description": "Miscellaneous M >=66.50- Tier None",
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              "payer_name": "Humana Insurance Company",
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      "description": "Miscellaneous M >=66.50- Tier Tier 2",
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          "setting": "inpatient",
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              "payer_name": "Devoted Health",
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    {
      "description": "Miscellaneous M >=66.50- Tier Tier 3",
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        {
          "code": "D2001",
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        {
          "setting": "inpatient",
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              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
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            {
              "payer_name": "Devoted Health",
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "methodology": "fee schedule"
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    {
      "description": "Miscellaneous M >=55.50 and M <66.50- Tier None",
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          "type": "LOCAL"
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        {
          "setting": "inpatient",
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          "code": "B2002",
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          "setting": "inpatient",
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          "code": "C2002",
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        {
          "setting": "inpatient",
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          "code": "D2002",
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          "setting": "inpatient",
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      "description": "Miscellaneous M >=46.50 and M <55.50- Tier None",
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        {
          "code": "A2003",
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        {
          "setting": "inpatient",
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              "payer_name": "Devoted Health",
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      "description": "Miscellaneous M >=46.50 and M <55.50- Tier Tier 1",
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        {
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        {
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      "description": "Miscellaneous M >=46.50 and M <55.50- Tier Tier 2",
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        {
          "code": "C2003",
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        {
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "payer_name": "Medicare (CMS)",
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              "methodology": "fee schedule"
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      "description": "Miscellaneous M >=46.50 and M <55.50- Tier Tier 3",
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        {
          "code": "D2003",
          "type": "LOCAL"
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        {
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      "description": "Miscellaneous M <46.50 and A >=77.50- Tier None",
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        {
          "code": "A2004",
          "type": "LOCAL"
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        {
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      "description": "Miscellaneous M <46.50 and A >=77.50- Tier Tier 1",
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        {
          "code": "B2004",
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        {
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    {
      "description": "Miscellaneous M <46.50 and A >=77.50- Tier Tier 2",
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        {
          "code": "C2004",
          "type": "LOCAL"
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      ],
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
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              "payer_name": "TRU Community Care dba Tru Pace",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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    {
      "description": "Miscellaneous M <46.50 and A >=77.50- Tier Tier 3",
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        {
          "code": "D2004",
          "type": "LOCAL"
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      ],
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        {
          "setting": "inpatient",
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              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "methodology": "fee schedule"
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              "payer_name": "TRU Community Care dba Tru Pace",
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    {
      "description": "Miscellaneous M <46.50 and A <77.50- Tier None",
      "code_information": [
        {
          "code": "A2005",
          "type": "LOCAL"
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      ],
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        {
          "setting": "inpatient",
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            },
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      "description": "Burns M <52.50- Tier Tier 3",
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            },
            {
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              "plan_name": "MA SNP",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 31855.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 31855.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
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              "estimated_amount": 31855.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 31855.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
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              "estimated_amount": 31855.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 31855.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 31855.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 31855.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 31855.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
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              "standard_charge_percentage": 100,
              "estimated_amount": 31855.67,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 31855.67,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 31218.56,
          "maximum": 31855.67
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      ]
    },
    {
      "description": "Short-stay cases, length of stay is 3 days or fewer- Tier None",
      "code_information": [
        {
          "code": "A5001",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 3031.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
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              "estimated_amount": 3031.27,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
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              "estimated_amount": 3031.27,
              "methodology": "fee schedule"
            },
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              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
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              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
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              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
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              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
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              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
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              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 3093.13,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 3031.27,
          "maximum": 3093.13
        }
      ]
    },
    {
      "description": "Expired, orthopedic, length of stay is 13 days or fewer- Tier None",
      "code_information": [
        {
          "code": "A5101",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 14744.19,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
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              "estimated_amount": 14744.19,
              "methodology": "fee schedule"
            },
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              "payer_name": "Devoted Health",
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              "estimated_amount": 15045.09,
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            },
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              "payer_name": "Devoted Health",
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              "estimated_amount": 15045.09,
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            },
            {
              "payer_name": "Devoted Health",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "estimated_amount": 15045.09,
              "methodology": "fee schedule"
            },
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              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
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              "methodology": "fee schedule"
            },
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              "payer_name": "SelectHealth",
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            },
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              "payer_name": "SelectHealth",
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              "methodology": "fee schedule"
            },
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              "payer_name": "SelectHealth",
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              "methodology": "fee schedule"
            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 15045.09,
              "methodology": "fee schedule"
            }
          ],
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        }
      ]
    },
    {
      "description": "Expired, orthopedic, length of stay is 14 days or more- Tier None",
      "code_information": [
        {
          "code": "A5102",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 35371.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 35371.21,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
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              "estimated_amount": 35371.21,
              "methodology": "fee schedule"
            },
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              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 36093.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 36093.07,
              "methodology": "fee schedule"
            },
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              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "methodology": "fee schedule"
            },
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "estimated_amount": 36093.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
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              "estimated_amount": 36093.07,
              "methodology": "fee schedule"
            },
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              "payer_name": "SelectHealth",
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              "estimated_amount": 36093.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
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              "estimated_amount": 36093.07,
              "methodology": "fee schedule"
            },
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              "payer_name": "SelectHealth",
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              "estimated_amount": 36093.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 36093.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "estimated_amount": 36093.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
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              "estimated_amount": 36093.07,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 36093.07,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 35371.21,
          "maximum": 36093.07
        }
      ]
    },
    {
      "description": "Expired, not orthopedic, length of stay is 15 days or fewer- Tier None",
      "code_information": [
        {
          "code": "A5103",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 16299.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 16299.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 16299.73,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
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              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
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              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
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              "standard_charge_percentage": 100,
              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 16632.38,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 16299.73,
          "maximum": 16632.38
        }
      ]
    },
    {
      "description": "Non-traumatic spinal cord injury M >=53.50 and M <60.50- Tier None",
      "code_information": [
        {
          "code": "A0502",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 19125.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 19125.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 19125.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 19515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 19515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 19515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 19515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 19515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
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              "estimated_amount": 19515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 19515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 19515.69,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 19515.69,
              "methodology": "fee schedule"
            },
            {
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      "description": "Non-traumatic spinal cord injury M >=48.50 and M <53.50- Tier Tier 2",
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    {
      "description": "Non-traumatic spinal cord injury M >=39.50 and M <48.50- Tier Tier 3",
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              "payer_name": "Denver Health Medical Plan",
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              "payer_name": "Medicare (CMS)",
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      "description": "Neurological M >=64.50- Tier Tier 2",
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        {
          "code": "C0601",
          "type": "LOCAL"
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        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 17634.55,
              "methodology": "fee schedule"
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              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 17634.55,
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              "payer_name": "Devoted Health",
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              "payer_name": "Devoted Health",
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              "payer_name": "Aetna Network Services",
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              "methodology": "fee schedule"
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              "payer_name": "TRU Community Care dba Tru Pace",
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              "payer_name": "SelectHealth",
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            },
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              "payer_name": "United Healthcare (UHC)",
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            },
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              "payer_name": "Denver Health Medical Plan",
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            },
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              "payer_name": "Medicare (CMS)",
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    {
      "description": "Neurological M >=64.50- Tier Tier 3",
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        {
          "code": "D0601",
          "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": 16462.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
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              "estimated_amount": 16462.81,
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            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
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              "estimated_amount": 16462.81,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 16798.79,
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            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
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              "estimated_amount": 16798.79,
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              "payer_name": "Aetna Network Services",
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            },
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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            },
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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            },
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              "payer_name": "TRU Community Care dba Tru Pace",
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              "payer_name": "SelectHealth",
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            },
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              "payer_name": "SelectHealth",
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              "payer_name": "SelectHealth",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "payer_name": "United Healthcare (UHC)",
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              "payer_name": "Denver Health Medical Plan",
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            },
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              "payer_name": "Medicare (CMS)",
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    {
      "description": "Neurological M >=52.50 and M <64.50- Tier None",
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        {
          "code": "A0602",
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        {
          "setting": "inpatient",
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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": 18831.11,
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            },
            {
              "payer_name": "Devoted Health",
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              "estimated_amount": 19215.42,
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            {
              "payer_name": "Devoted Health",
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            {
              "payer_name": "Devoted Health",
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            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "estimated_amount": 19215.42,
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            },
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              "payer_name": "TRU Community Care dba Tru Pace",
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              "payer_name": "SelectHealth",
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              "payer_name": "SelectHealth",
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            },
            {
              "payer_name": "SelectHealth",
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            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "estimated_amount": 19215.42,
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              "payer_name": "United Healthcare (UHC)",
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            },
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    {
      "description": "Neurological M >=52.50 and M <64.50- Tier Tier 1",
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        {
          "code": "B0602",
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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": "Devoted Health",
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              "estimated_amount": 30484.56,
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            {
              "payer_name": "Devoted Health",
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            {
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              "payer_name": "TRU Community Care dba Tru Pace",
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              "methodology": "fee schedule"
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              "payer_name": "SelectHealth",
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "payer_name": "United Healthcare (UHC)",
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            },
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              "payer_name": "Denver Health Medical Plan",
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    {
      "description": "Neurological M >=52.50 and M <64.50- Tier Tier 2",
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        {
          "code": "C0602",
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        {
          "setting": "inpatient",
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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": "Devoted Health",
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              "estimated_amount": 22824.08,
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            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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            {
              "payer_name": "Devoted Health",
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              "payer_name": "Aetna Network Services",
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "methodology": "fee schedule"
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "methodology": "fee schedule"
            },
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              "payer_name": "TRU Community Care dba Tru Pace",
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              "methodology": "fee schedule"
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              "payer_name": "SelectHealth",
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              "methodology": "fee schedule"
            },
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              "payer_name": "TriWest Healthcare Alliance Corporation",
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            },
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              "payer_name": "United Healthcare (UHC)",
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            },
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              "payer_name": "Denver Health Medical Plan",
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            },
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              "payer_name": "Medicare (CMS)",
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    {
      "description": "Neurological M >=52.50 and M <64.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0602",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 20880.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "standard_charge_percentage": 98,
              "estimated_amount": 20880.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 20880.32,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "standard_charge_percentage": 100,
              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 21306.45,
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            },
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
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              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 21306.45,
              "methodology": "fee schedule"
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          "minimum": 20880.32,
          "maximum": 21306.45
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    {
      "description": "Neurological M >=43.50 and M <52.50- Tier None",
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        {
          "code": "A0603",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 22188.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 22188.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 22188.55,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22641.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 22641.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 22641.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 22641.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
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              "estimated_amount": 22641.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "estimated_amount": 22641.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 22641.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 22641.38,
              "methodology": "fee schedule"
            },
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              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 22641.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 22641.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 22641.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 22641.38,
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            },
            {
              "payer_name": "Denver Health Medical Plan",
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              "standard_charge_percentage": 100,
              "estimated_amount": 22641.38,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 22641.38,
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          ],
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      ]
    },
    {
      "description": "  Neurological M >=43.50 and M <52.50- Tier Tier 1",
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        {
          "code": "B0603",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
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            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 35201.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 35201.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
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              "estimated_amount": 35201.75,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
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              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
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              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
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              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
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              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
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              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
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              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
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              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
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              "estimated_amount": 35920.15,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 35920.15,
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          "maximum": 35920.15
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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",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 26354.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 26354.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
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              "estimated_amount": 26354.34,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
            {
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              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
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              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
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              "payer_name": "SelectHealth",
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              "standard_charge_percentage": 100,
              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
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              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
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              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
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              "standard_charge_percentage": 100,
              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
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              "standard_charge_percentage": 100,
              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 26892.18,
              "methodology": "fee schedule"
            }
          ],
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          "maximum": 26892.18
        }
      ]
    },
    {
      "description": "Neurological M >=43.50 and M <52.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0603",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
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              "estimated_amount": 24602.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 24602.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 24602.94,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
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              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "SelectHealth Med Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TriWest Healthcare Alliance Corporation",
              "plan_name": "VA CCN",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "United Healthcare (UHC)",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Denver Health Medical Plan",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Medicare (CMS)",
              "plan_name": "Medicare",
              "standard_charge_percentage": 100,
              "estimated_amount": 25105.04,
              "methodology": "fee schedule"
            }
          ],
          "minimum": 24602.94,
          "maximum": 25105.04
        }
      ]
    },
    {
      "description": "Neurological M <43.50- Tier None",
      "code_information": [
        {
          "code": "A0604",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare PPO",
              "standard_charge_percentage": 98,
              "estimated_amount": 27827.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare Network PFFS",
              "standard_charge_percentage": 98,
              "estimated_amount": 27827.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Humana Insurance Company",
              "plan_name": "Medicare HMO",
              "standard_charge_percentage": 98,
              "estimated_amount": 27827.42,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA HMO (including POS)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28395.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA PPO (EPO and SNP)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28395.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
              "plan_name": "MA SNP",
              "standard_charge_percentage": 100,
              "estimated_amount": 28395.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Aetna Network Services",
              "plan_name": "Medicare Advantage",
              "standard_charge_percentage": 100,
              "estimated_amount": 28395.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage HMO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28395.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "Elevance fka Anthem Blue Cross and Blue Shield",
              "plan_name": "Medicare Advantage PPO",
              "standard_charge_percentage": 100,
              "estimated_amount": 28395.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "TRU Community Care dba Tru Pace",
              "plan_name": "PACE (Program of All-inclusive Care for the Elderly)",
              "standard_charge_percentage": 100,
              "estimated_amount": 28395.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Medicare Advantage Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 28395.33,
              "methodology": "fee schedule"
            },
            {
              "payer_name": "SelectHealth",
              "plan_name": "Select Health Value Network",
              "standard_charge_percentage": 100,
              "estimated_amount": 28395.33,
              "methodology": "fee schedule"
            },
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    {
      "description": "Fracture of lower extremity M >=52.50 and M <61.50- Tier Tier 2",
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    {
      "description": "Fracture of lower extremity M >=52.50 and M <61.50- Tier Tier 3",
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    {
      "description": "Fracture of lower extremity M >=41.50 and M <52.50- Tier None",
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        {
          "code": "A0703",
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        {
          "setting": "inpatient",
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              "payer_name": "Humana Insurance Company",
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            },
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              "payer_name": "TRU Community Care dba Tru Pace",
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    {
      "description": "Fracture of lower extremity M >=41.50 and M <52.50- Tier Tier 1",
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        {
          "code": "B0703",
          "type": "LOCAL"
        }
      ],
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        {
          "setting": "inpatient",
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            },
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              "estimated_amount": 33771.2,
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            },
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              "payer_name": "TRU Community Care dba Tru Pace",
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    {
      "description": "Fracture of lower extremity M >=41.50 and M <52.50- Tier Tier 2",
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        {
          "code": "C0703",
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        }
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        {
          "setting": "inpatient",
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            },
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              "payer_name": "TRU Community Care dba Tru Pace",
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            },
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            },
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      ]
    },
    {
      "description": "Fracture of lower extremity M >=41.50 and M <52.50- Tier Tier 3",
      "code_information": [
        {
          "code": "D0703",
          "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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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Humana Insurance Company",
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              "payer_name": "Devoted Health",
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              "payer_name": "Devoted Health",
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            },
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              "payer_name": "TRU Community Care dba Tru Pace",
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            },
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            },
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            },
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      ]
    },
    {
      "description": "Expired, not orthopedic, length of stay is 16 days or more- Tier None",
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        {
          "code": "A5104",
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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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              "estimated_amount": 43112.14,
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              "methodology": "fee schedule"
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            },
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            },
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            },
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              "methodology": "fee schedule"
            }
          ],
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      ]
    },
    {
      "description": "Stroke M >=72.50- Tier None",
      "code_information": [
        {
          "code": "A0101",
          "type": "LOCAL"
        }
      ],
      "standard_charges": [
        {
          "setting": "inpatient",
          "payers_information": [
            {
              "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": "Devoted Health",
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              "methodology": "fee schedule"
            },
            {
              "payer_name": "Devoted Health",
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              "payer_name": "Aetna Network Services",
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              "estimated_amount": 13374.64,
              "methodology": "fee schedule"
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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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